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Maryland Gov. Hogan sounds caution about scrapping COVID-19 vaccine plans to redistribute second doses

Gov. Larry Hogan confirms the first two cases of the UK Variant coronavirus in the state of Maryland.

Maryland has no immediate plans to overhaul its coronavirus vaccine distribution plans to begin injecting all seniors earlier, Gov. Larry Hogan said Tuesday, despite top Trump administration officials urging states to do just that.

Hogan said the speed of vaccinations in Maryland, a cause of serious concern and criticism two weeks ago, has picked up dramatically and now exceeds the pace at which the federal government is shipping doses to the state. The governor said Maryland doesn’t yet have nearly enough vaccine doses to cover all seniors.

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The federal pressure to revamp vaccine rollout plans comes as coronavirus infections continue to surge past record levels and as the first known cases of a newly, highly infectious variant of the coronavirus were discovered in Maryland.

Hogan announced Tuesday that the variant — first identified in the United Kingdom — was discovered in an Anne Arundel County resident who’d recently traveled abroad. That person and their spouse both tested positive for the variant. They are in quarantine with their two children and have not been hospitalized.

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The county health officer, Dr. Nilesh Kalyanaraman, said state and local public health officials are working to trace any contacts of the couple and test them for potential infections.

Public health experts fear the variant could further fuel the rapid spread of COVID-19, even as hundreds of thousands receive vaccinations against the disease.

Without assurances from manufacturers and federal officials that they can ramp up production and delivery soon, Hogan said, rushing out the state’s supply of second doses risks upending the vaccine rollout. The second doses are reserved as booster shots for people who already have received a first dose.

The change could leave Maryland with “a bare cupboard” when front-line health workers and vulnerable nursing home residents come due for their second dose, the governor said.

“We have to make sure we have those second doses or we’re in big trouble,” Hogan said at an afternoon news conference at the State House in Annapolis.

U.S. Health and Human Services Secretary Alex Azar, a former pharmaceutical executive who’s helped lead vaccine efforts for the Trump administration, told ABC’s “Good Morning America” on Tuesday that states should expand vaccine eligibility to all Americans over age 65 and to those with underlying health conditions that put them at higher risk.

“Our manufacturing is predictable enough that we can ensure second doses are available for people from ongoing production,” Azar said. “So, everything is now available to our states and our health care providers.”

Hogan painted a different picture of the rollout so far. About 1.5 million Marylanders would be eligible under the criteria outlined by Azar, Hogan said, but the state has only 300,000 doses of the vaccine. Hogan said he feared creating massive lines or swamping providers with vaccine requests without any ability to fulfill demand.

“I don’t want to have vaccines laying around. I also don’t want to run out and not get to second doses,” Hogan said. “Right now, we don’t have enough for front-line health care workers and the people who live in long-term care facilities.”

Immediately expanding eligibility to everyone over age 65 could mean people in Maryland’s Phase 1B priority group — currently next in line for the vaccine — would have a harder time securing a shot. That group includes teachers, residents of assisted living facilities and group homes, people with intellectual and developmental disabilities, and key government employees.

Skipping second doses for the time being has been the subject of heated debate among scientists and public health experts in recent weeks. A single dose likely confers at least some protection against COVID-19, although it’s unclear how much or how long-lasting such protection might be, since clinical trials of the vaccines used two doses separated by either 21 or 28 days, depending on the vaccine.

Each state has a plan for who should be vaccinated, based on recommendations from the U.S. Centers for Disease Control and Prevention. Earlier CDC recommendations gave the highest priority to health care workers and nursing home residents.

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But the slow pace of the rollout has frustrated many Americans at a time when the coronavirus death toll has continued to rise. More than 376,000 people have died, according to a Johns Hopkins database. Maryland reported 67 new COVID-19 deaths Tuesday, the highest daily total since May 12, and 1,952 infected patients in hospitals.

Pushing out more doses of the vaccine instead of holding supplies for a second shot would reach more people, but could leave people at greater risk for the disease vulnerable if further production and distribution problems pop up in the coming weeks.

Dr. Jennifer Nuzzo, lead epidemiologist for Hopkins’ coronavirus resource center’s Testing Insights Initiative, said calls from the Trump administration and incoming administration of President-elect Joe Biden to push out those second doses are an indication of growing confidence in the vaccine supply chain so that, “when it’s time to come back, there will be a dose for you.”

“What we really mean is, if you get vaccinated today, we’re not going to take a (second) dose and keep it in the freezer,” Nuzzo said.

The federal government will soon send Maryland another $54 million to fund COVID-19 vaccinations as part of a coronavirus relief package Congress passed in December, the Democrats in Maryland’s congressional delegation announced Tuesday, in addition to another $348 million in federal funds to expand testing and contact tracing in the state.

There would be major logistical hurdles if Maryland abruptly switches its vaccination rules to include anyone over age 65, Nuzzo said. Hospitals, clinics and nursing homes have been the scenes of most of the vaccinations so far. She said distributing vaccines to the wider public would mean either delivering doses to local doctors and pharmacists or setting up mass vaccination clinics.

Either way, vaccines won’t be widely distributed in time to stop the current wave of infections, Nuzzo said. The dire situation — including the even more explosively contagious variant — make mitigation and public health measures like mask wearing, social distancing, testing and contact tracing extremely urgent, she said.

“What a great shame it would be if we just achieved this enormous scientific achievement of developing a vaccine within a year and a lot of people die before they can get it,” Nuzzo said. “The vaccine is a great tool, but it’s not going to save us in the near term.”

Andrew Pekosz, a Johns Hopkins professor of microbiology and immunology who studies the coronavirus, agreed with Hogan’s reluctance to expand vaccine eligibility now, given the proven effectiveness of the two-dose schedule. But Pekosz hoped that will change as factories begin to churn out more doses.

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“Vaccine manufacturers seem to be having steady increases in production, so maybe by next week or soon, the situation changes and we can expand and vaccinate more people while keeping the two-dose schedule,” Pekosz said.

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Dr. Kathleen Neuzil, director of the University of Maryland School of Medicine’s Center for Vaccine Development and Global Health, said the confirmation of cases of the coronavirus variant in the state “emphasizes the need to vaccinate as many people as we can as fast as we can, starting with essential workers and those most vulnerable to infection, as we are doing.”

Neuzil, whose institution participated in both the Pfizer and Moderna vaccine trials and is taking part in an ongoing study of a Novavax vaccine, said vaccination plans require “a balancing act” between speedy distribution and managing supply that “we will never get exactly right.”

Additional new vaccines winning regulatory approval would help speed distribution, Neuzil said, but stretching supplies of the current two-dose vaccines also could be effective.

“While that second dose is extremely important, we shouldn’t be overly anxious if that second dose is delayed by a couple weeks, as long as we are compliant with the other forms of prevention: masks, social distancing, hygiene, frequent testing, isolation and quarantine,” Neuzil said.

Hogan said he spoke with CDC Director Robert Redfield on Monday in Annapolis and has plans to meet with the White House’s Coronavirus Task Force and other state governors to discuss the issue. Hogan said Biden’s incoming administration also has several proposals to accelerate vaccinations.

Tweaks to Maryland’s vaccination plans might come later in the week, Hogan said, but he suggested a significant reworking of plans seems unlikely.

“Our plan is very well thought-out,” Hogan said.

Baltimore Sun Media reporter Danielle Ohl and The Associated Press contributed to this article.

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