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Maryland counties face common COVID vaccine complication: people trying to cut in line by sharing links

As Maryland works its way through the phases of its COVID-19 vaccination plan, the state’s jurisdictions are facing a common complication: those trying to cut in line.

Local health departments have found that, even though eligibility to receive one of the scarce vaccine doses is limited to certain ages and occupations, people from outside those categories are scheduling appointments in the state’s PrepMod system. It’s a repeated issue that has caused the cancellation or rescheduling of some clinics and appointments.

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Health officials suspect people who are eligible and receive an emailed link to sign up for vaccinations are sharing them with their family, friends and, sometimes, wider audiences.

“It takes a life of its own pretty quickly,” said Tonii Gedin, Anne Arundel County’s deputy health officer of public health.

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But such efforts rarely lead to someone getting vaccinated prematurely, health officials noted. Clinics typically are designated for specific groups and if someone scheduled for a clinic doesn’t meet the qualifications — such as a 39-year-old on a list for a 75-and-older clinic, as Carroll County Health Department health planner Maggie Kunz has seen — the departments generally notify them beforehand that they aren’t eligible yet.

They also send out follow-up emails with reminders of the eligibility requirements, Gedin said, and, in most cases, see some applicants cancel their appointments when they realize they won’t be vaccinated.

Baltimore City, for example, recently canceled numerous appointments scheduled at Baltimore City Community College, currently a second-dose-only site, when it was discovered that “hundreds” of first-dose appointments were booked. A letter the Baltimore City Health Department sent to the Baltimore City Council referenced the link-sharing, saying complaints about it to the state have been “ongoing since late December with no solution offered.”

“We know that vaccine demand is high right now, and with time, and with our partners, we will vaccinate our communities rapidly and equitably,” the department said in a statement. “We are continuing to work with the Maryland Department of Health to address challenges and bottlenecks found in the State’s PrepMod system.”

Sometimes, though, those catches aren’t made until residents arrive for appointments and are turned away when they can’t offer proof of the employment they said they had to justify their scheduling. In that case, a hard-to-come-by time slot — and potentially a vaccine dose — that could’ve been used for someone eligible goes unused.

“Our goal is to be able to vaccinate as many people efficiently and safely as possible, so when someone tries to get a vaccine for which they’re not eligible, then that takes away from someone who is eligible,” said Dr. Maura Rossman, Howard County’s health officer. “Across Maryland, we know that there’s far more people who want to be vaccinated than we have vaccines, so that’s what’s mostly disappointing about this.”

Hank Greenberg, the state director of Maryland AARP, said the trend is particularly concerning for the state’s older residents, who are considered more at-risk to the viruses’ effects.

Further complicating their pursuit of vaccination, he said, is Maryland’s lack of a centralized system for signing up for appointments, leading seekers on a “scavenger hunt” and challenging those seniors who lack access to or struggle with technology.

“It’s not surprising that people are sharing links among family and friends out of desperation, creating this underground system for registration,” Greenberg said. “Anytime there are scarce resources, there are going to be people trying to help each other. But this is not an online race for a PlayStation 5.”

Gedin said there may be rare exceptions made, offering the example of a 75-year-old sharing with his 74-year-old wife who’s only a month shy of her 75th birthday. But if the couple’s 18-year-old grandson also arrived at the clinic, he would be told to wait until he was eligible.

“We just don’t have the vaccine to do it,” Gedin said. “We understand. I don’t question why people are doing this. They’re looking to be vaccinated. They’re looking to make sure their families are safe, and they’re trying anything they can. The resource is scarce, and it’s a lifesaving resource, so I don’t fault people oftentimes for trying, but also need them to understand.

“Because we can’t do it for everyone, it makes it hard to do it for anyone.”

Representatives from several jurisdictions said the emails featuring the links also include messages in bold lettering telling recipients not to share them, but those messages still can go unnoticed or ignored.

But the links themselves, a product of the state’s PrepMod system that’s been in use for vaccine appointment scheduling since December, feature no limitations that might keep those who inappropriately receive the link from using it, such as one-time use or two-factor authentication based on the intended recipient’s personal information. The links stop being usable, health officials said, only once all the appointments in their related clinics are booked.

In a statement, Charlie Gischlar, a spokesman for the Maryland Department of Health, said the state is working to find solutions.

“We have heard of other situations where appointment registration links were shared with unintended recipients,” Gischlar said. “Citizens must understand that the unauthorized use of a private registration link can take an appointment slot away from an individual in a priority group. The state is closely monitoring this situation and is working with our vaccine registration partners to address this.”

Dr. David Bishai, Harford County’s health officer, said because many of the eligible residents purposefully receiving the links are older and might have technological difficulties, there’s a need to keep the process simple. Even placing a time limit on the links would favor those with consistent access to their phones and emails, he said.

“That’s the trade-off: The URL is sort of hanging out there, open,” Bishai said. “The downside of openness is the potential for misuse.”

For both approved vaccines, Pfizer/BioNTech and Moderna, two doses are needed for full vaccination. Clinics have specifically allocated doses for second shots to ensure that all those who receive the first get their second within the specified time, three to four weeks depending on the brand of the vaccine. Similar to the Baltimore City Community College cancellations, Bishai said Harford County recently had to redo all of the sign-ups for a second-dose clinic after discovering many first-dose seekers among those who had signed up.

Kunz acknowledged that she wished “the system was a little smoother” and said the problem could be eliminated by calling those who are eligible rather than emailing, but the number of needed calls would make that difficult. Those who are older or lack access to technology are still receiving calls, with Bishai saying Harford County has almost 200 volunteers working to schedule appointments.

The best solution, Rossman and Bishai said, will be improved availability of vaccines. About 9.2% of Marylanders have received at least one dose of the vaccine, with slightly fewer than 1 in 35 residents being fully vaccinated, according to state data as of Tuesday morning.

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“The supply is increasing, and this crisis will hopefully be gone in a couple months once this vaccine is as available as the flu shot was last year,” Bishai said. “That’s the future. This is a temporary crush, and I hope it does bring out the best in people.”

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