It is an online scavenger hunt that often ends in futility, or in some cases, the cold parking lot of a COVID-19 vaccine clinic, turned away without that precious shot in the arm.
Almost two months after the first doses of the coronavirus vaccine arrived in Maryland, a sign-up process that involves scrounging through multiple websites for seemingly phantom appointments has everyone from legislators to doctors to a desperate public asking: Isn’t there a way to go on a single site to request and schedule a shot?
In other locales, the answer is yes.
“You see the result of not doing that in other states,” said Matt Bieber, a spokesman for the New Mexico Department of Health.
His state has won plaudits for its one-stop sign-up process, which matches residents to nearby providers when they have available shots. It has helped New Mexico rank among the top states for quickly administering their allotted doses. While Maryland has improved its percentage of doses administered, it ranked 36th on that metric last week as measured by The New York Times.
Some say that New Mexico and other high-ranking states generally have smaller populations, which at least theoretically could make it easier to streamline their efforts.
But as frustration grows across the country among those who have fruitlessly clicked on website after website — or as in Baltimore recently, were turned away after a city health department site was overbooked — Maryland is under pressure to adopt what other states have done to improve how it gets vaccines to people more efficiently.
Much of the focus has been on Maryland’s online portal, which like many other states refers users to the websites of hospitals, pharmacies, health departments and other vaccine providers — each of which has its own enrollment system for what are still exceedingly scarce appointments.
Maryland and federal lawmakers have called for the state to switch to a one-stop site and otherwise improve its delivery of vaccines, even as most say the underlying problem is inadequate supplies, at least at the moment.
While states await the promised increase in allotments, with ramped-up production of the two currently approved vaccines and development of new ones on the horizon, officials can improve how they manage what they have on hand, experts say.
“There are states that are doing a good job, and states that aren’t doing as good a job,” said Steven W. Chen, an associate dean of the University of Southern California School of Pharmacy who reviewed how states have handled the enrollment and distribution of the vaccine.
“We need to learn from the best practices of those states,” he said, “and not re-invent the wheel.”
Whether you’re talking about a single enrollment site or the storing and distribution of the vaccines themselves, Chen concluded, “There are a lot of good arguments for centralization.”
Chen, who wrote about his findings for The Conversation, an online news outlet, points to how a country like Israel, whose national health care system is administered through just four HMOs, leads the world in vaccination rates.
What we’re seeing now in the United States, he says, is the cost of a more fractured health care system.
He and others note that while there has been some federal guidance on vaccines, states have leeway on issues such as who to vaccinate first, how quickly to add new phases of eligible groups, and how to allocate and distribute doses. In turn, the states have given counties and cities leeway as well, leaving residents to navigate a sometimes confusing and conflicting patchwork of rules and registration systems in search for a shot.
Saying members have complained about computer screens freezing, links not working and long waits when they try to phone for help, the Maryland director of the AARP wrote Gov. Larry Hogan Jan. 25 to urge he provide a more user-friendly, one-stop site for getting a vaccine.
“The current system to sign up for a vaccination is not working as it should,” Hank Greenberg said.
Dr. Gabe Kelen, an emergency medicine physician who heads the Johns Hopkins Office of Critical Event Preparedness and Response, agreed.
“There are multiple sites all over the state that are not connected to each other,” he told a House of Delegates committee Tuesday during a briefing on vaccine distribution.
Vaccine seekers are “enrolling all over the place, just clogging everyone’s enrollment site,” Kelen said.
Several lawmakers on the Health and Government Operations Committee clearly agreed, relaying constituent experiences of logging onto multiple sites, inputting information repeatedly, only to learn there are no appointments available.
“Constituents pointed out that there seems to be some inconsistency across jurisdictions,” said Del. Harry Bhandari, a Baltimore County Democrat. “Really, it just seems there are issues with coordination and communication.”
Acting Maryland Health Secretary Dennis R. Schrader defended the current system to the committee, saying the department has had success with the “aggregating and referring” model that directs vaccine seekers to various providers, who he said prefer to use their own registration and scheduling system.
Legislators pushed back, citing data showing that much of Maryland’s vaccine supply remains unused. According to data from the Centers for Disease Control and Prevention, as of Friday, the state had administered 58% of its allotment.
Del. Robbyn Lewis, a Baltimore Democrat, said she would grade Maryland “C-minus” compared to other states and wondered what it would take to bring that “up to par with states like West Virginia that are outperforming us.”
West Virginia generally ranks in the top tier of states for using up its allotments, something that has been attributed to its more centralized approach.
Answering Lewis’ question may be difficult, some experts say, because what works in one locale may not work in another.
“It’s apples to oranges,” said Rupali J. Limaye, an associate scientist at the Johns Hopkins Bloomberg School of Public Health who specializes in vaccine behavior and decision-making.
Limaye said states are contending with populations of different sizes, demographics and needs, and have to tailor their approach, whether they’re trying to serve a rural population, for example, or one without internet access.
What’s important is clarity — people need to know in which category of eligibility they fall, which varies by jurisdiction, and where they can receive a vaccination once their turn comes up, she said.
“There has to be an easy way to track where people are in the process,” Limaye said. “It has to be clear when you’re eligible, and where you can go.”
Limaye said she believes given all the challenges, Maryland’s website generally does a good job showing users which phase they’re in and where vaccines are offered.
But the site remains a source of frustration for some, especially those anxious to get the vaccine as quickly as possible due to their vulnerability.
Randi Madar said she’s spent weeks trying to find a vaccine for her 73-year-old husband, a cancer researcher battling an advanced stage of the disease. The Pikesville resident said she’s filled out form after form and gotten nothing more than some variant of “We’ll contact you.”
Madar, 56, said she was desperate. The Baltimore County school teacher has asthma and other medical conditions. She has applied for family leave to avoid returning to the classroom, potentially contracting the virus and bringing it home to her immuno-compromised husband.
Igal Madar said although he continues to work on a federally funded breast cancer study at Hopkins, he is no longer on the staff and didn’t qualify to be vaccinated along with others working in the health care field.
Last weekend, his wife turned to him and said, “Let’s just take a chance.”
They packed the wheelchair he sometimes uses into the car and headed to the Maryland State Fairgrounds in Timonium, where a Baltimore County health department clinic has been vaccinating those lucky enough to get appointments.
Maybe at the end of the day there will be leftovers that need to be used up, she said.
Providers generally ban or at least strongly discourage what has come to be called “vaccine scavenging,” but some people have reported they received shots by being in the right place at the right time — such as at a grocery store or pharmacy at the end of the day when extra doses that have been thawed out must be used or thrown away.
The Madars, however, said they were not allowed to wait at the facility and instead were escorted out. Randi Madar said she was upset and called a county hotline and emailed the county health officer, Dr. Gregory Wm. Branch, to complain about their treatment.
“It’s not OK,” Igal Madar said, being made to feel like a criminal when all he wanted was the vaccine.
“These vaccines are paid for by our tax dollars,” he said. “It belongs to me like it belongs to everyone.”
On Thursday, Branch said he has not seen an email but was told some details of the incident. He defended his staff, and said no one without an appointment is allowed to wait for doses that may remain at the end of the day. In such an eventuality, they are used to continue vaccinating county staff such as firefighters, he said.
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Branch said there simply isn’t enough supply at the moment to meet the extraordinary demand. With the fairgrounds, a new site in Randallstown and another in the works, he said the county will vaccinate as many residents as it can as soon as more supplies arrive.
“Please be as patient as you can,” he said.
That would be John D. Grabenstein’s advice as well. A former Army colonel who previously oversaw Defense Department immunization programs, he co-chairs a group of health professionals who have organized as the COVID-19 Vaccine Analysis Team, or COVAT, to serve as a resource on vaccine issues.
Grabenstein, who lives in Easton, said the public needs to remember “we’re still in the early days” of manufacturing complicated vaccines and distributing them across vast areas. There’s not just one learning curve, he said, but “tens of thousands of learning curves.”
While he understands the appeal of a one-stop sign-up system, he questions how the various vaccine providers, public and private, all on different systems, can “talk to one another.”
And having separate systems has its advantages, Grabenstein said.
When the Baltimore City clinic experienced its overbooking problem, for example, at least it was limited to one clinic rather than the entire state.