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Maryland’s COVID vaccine allotment to counties adding to confusion of rollout

Faced with growing questions over how they’re dividing up some of Maryland’s share of COVID-19 vaccines, state officials released Friday how many doses will be allotted to each local health department in the coming weeks, a list that revealed wide disparities between them and failed to allay concerns over equity.

The Baltimore City Health Department will receive 2,000 doses each of the next four weeks, for example, compared to Baltimore County’s agency, which will get 4,900 doses each week, even though the county’s population is only somewhat larger than the city’s. Anne Arundel County, slightly smaller than the city, is getting 3,400 doses.

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Meanwhile, the state’s two most populous counties, Montgomery and Prince George’s, are receiving less than Baltimore County.

Lawmakers and local health officials remain concerned about equity and fairness because the state still isn’t disclosing information about how it’s distributing the bulk of the roughly 88,000 doses Maryland has been receiving every week from the federal government.

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Only about a third of the state’s vaccines go to the public health departments, which say they serve the most vulnerable members of the community. The state has said it’s sending 14,000 to 15,000 doses a week to the state’s two newly opened mass vaccination sites. But state health officials are not releasing how many are being sent to hospitals, pharmacies, groceries and federally qualified health centers.

“Why are they keeping a secret as to how they are allocating the vaccine?” said Sen. Clarence Lam, a physician who represents parts of Baltimore and Howard counties.

He said Gov. Larry Hogan and Dennis Schrader, Maryland’s acting health secretary, have touted equity as the priority in the vaccine rollout, but it’s impossible to know how well they’re meeting that goal.

Baltimore Mayor Brandon Scott reiterated Friday his call for more information on how the vaccine is allotted.

“As I’ve been emphasizing for weeks, we will not have an equitable distribution of the vaccine until we start getting clear, transparent information from the State,” Scott said in a statement released by his office. “This is critical to being able to vaccinate Baltimore residents efficiently and equitably.”

Ed Singer, Carroll County’s health officer, said the 1,000 weekly doses his county will receive are inadequate for the seniors over 75 whom the state wants vaccinated as quickly as possible. And this is the population that the county health department is best able to reach, he said.

“These people, they don’t have computers and email capability, and they can’t sign up for a clinic at Six Flags,” he said, referring to the state’s mass vaccination site at the Bowie amusement park more than an hour away from Westminster, the county seat. “Nor do they want to drive there.

“They need us to call them and actually schedule them,” Singer said. “Some people are homebound and it requires we actually go to them.”

The Harford County Health Department is getting 1,400 doses a week under the state’s plan released Friday, while Howard County’s will receive 1,700.

Tensions have been brewing in recent weeks between the localities and the Hogan administration over vaccine allotment. Legislators have taken state health officials to task at committee hearings for how they have been distributing the vaccines as well as for the frustrations their constituents experience clicking through website after website in an often fruitless attempt to land a coveted appointment for a shot.

Earlier this week, the Maryland Association of Counties wrote Hogan, a Republican, calling on him to prioritize local agencies in allocating vaccines, rather than spreading them out through more and more outlets. The fight escalated when Hogan fired back during a news conference Thursday and said the health departments represent just a fraction of the vaccines allocated to each jurisdiction.

Hogan said some localities wanted the state to route its vaccine doses exclusively through country health departments, which he dismissed as “absurd” and “not a realistic way to vaccinate millions of people.”

His administration contends that adding more public and private outlets providing the shots is the way to build a robust vaccination infrastructure, in preparation for an expected influx of doses. The federal government could authorize another, single-dose vaccine candidate as soon as this month, easing a critical shortage of doses that has slowed the nation’s vaccination efforts.

Singer took issue with Hogan’s characterization of what the localities want.

“I heard him say health departments want a monopoly on the vaccine,” Singer said. “But that’s not the case. What we’re looking for while we have a very limited supply is to prioritize people over 75 and others most vulnerable.”

The lack of information on how many doses each of the providers is receiving, though, hampers the entire effort, one state lawmaker said.

“The local health departments do need to know who is being vaccinated by local doctors, who is being vaccinated at the local pharmacies, because if they don’t know that, they can’t see where the gaps are that they need to fill,” said Sen. James C. Rosapepe, who represents portions of Prince George’s and Anne Arundel counties and sits on the Senate Vaccine Oversight Workgroup.

Rosapepe said the addition of pharmacies and retail providers to the state’s vaccination campaign will provide convenient, reliable and trustworthy options for many Marylanders once supply scales to match demand. But health departments, already experienced in dealing with communicable diseases and mobilizing effective community outreach, still have a critical role to play in vaccinating those likely to fall through the cracks.

The call for more information on just where doses are going comes as Marylanders continue to struggle with a cumbersome enrollment system that requires them to navigate the websites of multiple providers.

Singer, who heads the Maryland Association of County Health Officers, and a group of county health leaders met with Hogan’s administration Wednesday. The county leaders were seeking greater transparency about where vaccines are going, prioritized allocations to local health departments and a fix for the state’s disorganized sign-up process for immunizations.

Michael Sanderson, executive director of the Maryland Association of Counties, attended the meeting and said it’s clear the overarching problem is the short supply. The state must work with counties to avoid costly hiccups until that eases, he said.

“County leaders want to impress on the administration what a negative result it is when somebody’s great-grandmother has her appointment canceled for her second vaccine dose,” Sanderson said.

Hogan’s staff and the county health leaders made some progress during their meeting, Sanderson said. But, he added, they “didn’t leave the room with a series of handshakes.”

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Some have questioned whether the state opened up additional outlets too soon.

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Maryland Sen. Addie Eckardt, a Republican who represents parts of the Eastern Shore, said the move has “created a firestorm” of confusion and anxiety among constituents and health officials.

“I know the plan is to engage the private sector, but to me, it seems it would have been better timed when we get additional vaccines,” said Eckardt, a practicing nurse who also sits on the Senate Vaccine Oversight Workgroup. “The health departments will know in their communities who’s at risk and where to deploy them. Will pharmacies be able to do that?”

Underlying the dispute is a concern over access to the vaccines, given that health departments, hospitals and private retailers have different, if at times overlapping clientele.

Monica Schoch-Spana, a medical anthropologist and senior scientist at the Johns Hopkins Bloomberg School of Public Health, said it’s important to make sure that groceries and pharmacies that receive vaccine allocations are spread evenly through communities.

“We have that existing food desert phenomenon,” she said, where entire neighborhoods are bereft of vital retail outlets.

But Cherokee Layson-Wolf, an associate dean at the University of Maryland School of Pharmacy, said pharmacies serve every socioeconomic group, and an industry survey found most Americans live within five miles of one.

Hogan and Schrader have focused on mass vaccination sites, at Six Flags and the Baltimore Convention Center, to greatly boost the more than 700,000 first doses of the vaccine that have already been administered. Another, at M&T Bank Stadium in Baltimore, will open later this month, with three more expected to come online in the weeks ahead.

But Dr. Larry Polsky, Calvert County’s health officer, said the mass vaccination sites were not designed for seniors or those who live in more remote areas of the state. He was alarmed to see his health department’s allocation slashed by 66% this week, which the state rebutted by saying health departments are just one mechanism by which they’re sending doses into counties.

“Once you can open it up to everyone, there will still be a role for public health,” Polsky said. “People are not all going to go driving out to Six Flags or the Convention Center.”

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