As Nation Speeds to Vaccinate All, Maryland’s Path Shows Challenges Ahead

UPPER MARLBORO, Md. – The road to rapidly vaccinating the country’s 250 million adults is being paved with pharmacy chains, hospitals and huge stadiums where uniformed troops vaccinate thousands of people every day.

It will also rely on the recreation center at Glenarden’s First Baptist Church here, along with tiny storefront service organizations and vaccine-filled vans searching the neighborhood for unprotected ones.

Maryland offers a microcosm of the problems states will face if they rush to open enough vaccination sites to meet President Biden’s goal of qualifying every adult for Covid-19 admissions by May 1. It has tackled almost all of the geographic, demographic, and human behavior problems associated with coming up with a public health task of this magnitude: poor neighborhoods where many lack access to regular care; affluent Washington suburbs whose residents have proven adept at sucking up records for other zip codes; isolated rural areas; and a registration system that has angered citizens so that the vaccine hunt has become for many part-time workers.

“We’re going to push, but we also have to push,” said Dennis Schrader, the incumbent health minister in Maryland, describing the state’s plan to not only increase capacity at mega-locations and pharmacies, but also to “attract people” with smaller, more targeted ones Efforts.

Virtually every state in the nation is currently in a dangerous race between vaccinating its residents and succumbing to a severe wave of cases, caused in part by the emergence of new variants of the coronavirus. As states rush to expand shooting eligibility, many are also relaxing the rules on eating, gathering, and masking.

Extensive group efforts across competing interests will be required to bring states closer to herd immunity. Efforts to track who is being vaccinated and where are becoming even more important so that health officials can quickly identify who is being left behind and change their strategies and resources accordingly.

Many states have already opened vaccination to all adults, including more than a dozen this week alone. To move the process forward, Mr Biden announced on Thursday a new advertising campaign aimed at communities where vaccine reluctance remains high.

“It will really be the start of a much stronger surveillance and analysis that is needed to ensure this has been both a quick and fair launch of the largest vaccination campaign in human history,” said Alison M. Buttenheim, Associate Professor at the University of Pennsylvania School of Nursing.

Here in Maryland, the pent-up demand for the vaccine is huge: only people age 65 and over, some types of essential workers, and some other narrow categories were eligible through March, so two-thirds of the population were still unprotected.

On Tuesday, Republican Governor Larry Hogan opened the vaccination to anyone 16 years and older who had certain medical conditions. Everyone aged 16 and over is eligible until April 27, regardless of medical status.

But while Mr Hogan has been heavily criticized by local leaders for the state being in the middle of the road, some people fear it is accelerating too quickly. Mr Hogan has already been criticized for not doing enough to reach the Black and Latino residents, who make up more than 40 percent of the state’s population, but only 28 percent of those who received at least one shot.

Hogan’s government plans to open four more mass vaccination sites by the end of April, bringing the number to 12. 320 pharmacies administer shots. Next week, an area operated by the federal government will open at a subway station. Mr. Hogan’s goal is to have 100,000 shots a day by May, up from an average of 57,000 a day.

The state has begun calling in primary care physicians with the goal of having 400 practices administering shots by May. It also works with local health departments and community partners, especially churches, to open pop-up vaccination sites that target populations who may be geographically or socially isolated, or who distrust the government and large institutions.

Updated

April 1, 2021, 4:46 p.m. ET

Pastor John Jenkins of the First Baptist Church in Glenarden understood the role his church could play as he drove down a main street in Prince George’s County – a mostly black area with high Covid infection rates but low vaccination rates – after winding a row of cars, leading to a mass vaccination site at Six Flags amusement park.

“The people in these cars didn’t look like the people in the county,” said Pastor Jenkins. “The people in this church couldn’t get appointments.”

With the help of his church’s long-time partner, the University of Maryland Capital Region Health, he and his army of church volunteers quickly created pop-up vaccination sites. State officials who provided contract workers visited his sprawling indoor recreation center and quickly agreed to significantly expand his initial dreams of several hundred shots a week.

The site, which functions like a medical center, planned to vaccinate a few hundred people a day, but was quickly getting closer with residents like Denise Evans who said she was “more comfortable” in her church than the stadium across the street approaching 1,000. The church will soon be ramping up to take daily recordings. “I am grateful that the governor has reallocated resources here,” said Pastor Jenkins.

Targeting smaller populations can also require special efforts. A group of Latino residents in Baltimore, given 25 seats in a state convention center, were often unable to reach the premises, and those who got there could not find anyone who spoke Spanish. The Esperanza Center in Baltimore, a unit of Baltimore Catholic Charities, was approached by the National Guard in February to work with Johns Hopkins to establish a clinic for that group at the Sacred Heart of Jesus.

“What was really important to us was that they didn’t wear uniform,” said Katherine Phillips, the center’s medical director. (Many of those who attend church are undocumented immigrants.)

The website uses a hotline to help residents make appointments and has recordings at their church on Friday evenings when more residents who otherwise couldn’t get off work can get there.

Another focus of criticism in Maryland, as in many other states, was the vaccine appointment scheduling system. Instead of having a single online portal where people can view available appointments across the state, each provider has its own online appointment system. This means that users often have to search multiple websites to find a slot. The state recently created a single online platform that residents can use to pre-register for an appointment at one of its mass vaccination sites. However, Mr Schrader, the incumbent health minister, said the hospital systems and pharmacy chains that operate most of the sites “want to use their own system.”

Dr. Josh Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health in Baltimore and former Maryland Secretary of Health, said he expected this approach to prove more problematic as more people seek appointments.

“This chaotic system of people having to go to 15 websites is really discriminating against people who don’t have a computer or who can’t spend all day on it,” said Dr. Sharpstein.

Mr Biden recently said his administration would help make it easier to find vaccine appointments, including by creating a federal government-sponsored website that will show people near the places where gunshots are being made and a toll-free line that people can call for help. He promised to find a vaccine by May 1st. He also promised to set up “technology teams” in states that need help improving their vaccine terminals.

To date, Maryland has sent about 30 percent of its weekly vaccine allocation to its high-volume locations, 30 percent to local health departments shared with community groups and other small providers, and the rest to hospital systems, pharmacies, and independent medical practices.

Going forward, Mr Schrader said the state will rely heavily on local health departments and community health centers to provide basic services to low-income and uninsured people in 126 locations across the country and receive their own allocation directly from the federal government. Among other things, they can compare their patient lists with the state vaccine register to find out who still needs a shot.

In Baltimore, where 21 percent of the population lives below the poverty line, local hospitals, pharmacies and a nursing school have teamed up with the city health department to send teams to public housing for the elderly at least six times a week and vaccinate more than 2,300 people there so far . The city will soon expand the program to other high-risk populations, said Dr. Letitia Dzirasa, the city’s health commissioner.

“It’s a little nerve-wracking to think that in a month’s time it will be completely open,” said Dr. Dzirasa.

Even so, she and other local officials across the state said they did not expect there to be shortages of vaccines or places where people could be shot. In Washington County, where large rural areas border Pennsylvania, Virginia, and West Virginia, Maulik S. Joshi, president and chief executive officer of Meritus Health, the local hospital system, said that between the county health department, the local aging committee, and his own co-worker, almost 3,000 employees, he was not concerned about the number of vaccine-compatible balloons.

“We put in people you wouldn’t believe,” said Dr. Joshi as he was preparing to open a mass vaccination site in an outlet center on a freeway in Hagerstown that was once a merino wool sweater and orange Julius outpost, now part of the medical center. “People from the areas of finance and outpatient rehabilitation care run our vaccination centers. We are hiring. We are ready to go. For us it is not a cost or a people problem, just a vaccine problem. “

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