The Trump administration revealed sweeping changes to its coronavirus vaccine distribution strategy Tuesday, in efforts to speed up the pace of the rollout and to inject the most vulnerable Americans more quickly—but Maryland Gov. Larry Hogan (R) announced no immediate plans to jump on board with the recommendations, even though the state has more than 70 percent of its allotted doses in storage, unused.
The federal government’s recent changes urge states to expand the current pool of vaccine eligibility to those 65 and older and those with underlying health conditions, as both groups are at greater risk of contracting the coronavirus. Health and Human Services Secretary Alex Azar said, “We’re telling states today that they should open vaccinations to all of their most vulnerable people. That is the most effective way to save lives now,” at a press briefing Tuesday.
Azar also disclosed that the administration would stop reserving second doses of the vaccines and instead, pump all available injections to states, as the number of cases and hospitalizations has surged to unseen levels.
But Hogan insisted on sticking with his own recently modified plans, largely based on guidance from the Centers for Disease Control and Prevention (CDC), targeting essential workers alongside seniors.
Hogan announced the measures last week amid the state being in Phase 1A, which vaccinates healthcare workers, residents and staff of nursing homes and first responders. Phase 1B now groups seniors aged 75 and over with teachers, prison inmates and “education and continuity of government” personnel, while seniors between the ages of 65 and 74 moved to Phase 1C—although seniors 65 and up make up roughly 80 percent of coronavirus deaths in the United States. Also included in Phase 1C are essential workers in lab services, agriculture, manufacturing, public transit and grocery stores. And residents with increased risk of severe coronavirus illness due to pre-existing conditions have downgraded to Phase 2—vaccinations that are unlikely to start until spring or summer.
The Maryland governor also rejected the move to make all doses available in the state—even though the incoming administration has also adopted making them all available. This change in strategy was done since there are no guarantees that manufacturers will be able to accelerate production to meet the needs of providing second doses within the designated timeline for residents who received the first injection.
“We have to make sure we have those second doses or we’re in big trouble,” Hogan said at a press conference Tuesday, arguing that the pace of vaccinations in the state has sped up.
Hogan’s decision adds to the pot of bubbling debate among medical professionals and public health experts, as some have argued that ensuring one dose of the vaccine by making all available would provide a partial shield against the virus to more Americans, although it’s unclear how effective it would be since the clinical trials for both Pfizer-BioNtTech and Moderna vaccines call for two doses, while others have said that it’s crucial to hold off part of the supply to warrant second doses.
“Our plan is very well thought-out,” Hogan said.
Maryland, however, stands behind similarly populated states like Indiana, Tennessee and Massachusetts in terms of the number of administered vaccines. Out of the 552,800 distributed doses in the state, only 146,231 residents have received the first dose of the vaccine, according to federal data released Tuesday.
“The primary challenge in the rollout continues to be a limited amount of vaccine allocated to the state by the federal government,” a Maryland Department of Health spokesperson said. “The state ensures that every dose allocated to us by the federal government is provided to our local distribution partners as quickly as possible, but we are limited by the number of doses that the federal government allocates.”
In Prince George’s County, home to 60,505 total infections, just 7,389 residents have been vaccinated, according to data reported Tuesday and in Washington County, the health department reported its “used next to none,” The Baltimore Sun wrote. Montgomery, Caroline and Calvert counties, however, have used up most of their doses.
Lois Privor-Dumm, director of adult immunization at the Johns Hopkins International Vaccine Access Center, said, “There have been many hurdles that all health systems have faced that make the distribution process challenging. The biggest is probably limited information on the number of doses and when the vaccine arrives,” noting that “if the vaccine is reactogenic,” hospital staff has to “stagger vaccinations” in case there is an adverse reaction. The coronavirus vaccine isn’t like the flu shot, where a person can just get it and leave. Instead, those who receive it must wait nearly fifteen minutes after, being monitored by staff.
Another logistical challenge has been creating internal prioritizations—or which frontline workers should be the first to get the vaccine within the individual hospitals depending on the amount of exposure to coronavirus patients.
“At a large health system, it takes time to determine who get[s] vaccinated first, particularly when it was not clear initially what the distribution would be or what vaccine acceptance would look like,” Privor-Dumm said. “Distribution is now starting to normalize, and now that we are past the holidays, things are beginning to improve.”
The slow rollout can also be due to the lack of refrigeration capacity, especially at smaller hospital systems, since both Pfizer and Moderna need ultra-cold temperatures for storage. There’s also an extensive process for unpacking, counting, inventorying, thawing and coordinating each dose of the vaccine.
Public health experts have pointed to a spate of issues blooming in nursing homes, a group that’s a part of Phase 1A, as some residents and facility staff are skeptical of receiving the vaccine and may need additional approval from family members in order to actually get inoculated.
To ease the logistical hurdles, Hogan announced changes to the state’s vaccination rollout program last week, where he called on the Maryland National Guard and Maryland volunteers to help hospitals and clinics to distribute and administer more vaccines—initiatives that “will continue to provide vaccination support personnel in the coming weeks and beyond,” according to the Maryland Department of Health spokesperson.
Hogan also offered more medical resources for hospitals, including personal protective equipment, vaccinators and logistical support and embraced a “rolling vaccine allocation model,” where the state department will not wait for all members within each priority to get inoculated before training to the next group.
“The governor has opened up vaccination to a wider group of those who can be vaccinated, but that doesn’t always lead to faster vaccination. There are several things that also need to happen—first, there needs to be good coordination with the local health departments so that everyone is communicating consistently about when product will be available and also about where,” Privor-Dumm said. “The health department will also need to look at equity to ensure that vaccinations are being given in the places where people may be at higher risk for severe disease, taking into account that communities may be hesitant, or not have access to care. It is like a jigsaw puzzle figuring out how much vaccine is needed, where, and ensuring that it is distributed in a fair manner.”
Maryland is on track to inoculate 1.8 million residents by the end of May—just 30 percent of the population—as 72,000 doses are slated to be delivered to the state each week.
But that number could increase if other vaccine candidates are proven to be safe and effective, like the prospective one from Johnson & Johnson, a pharmaceutical giant that would offer just one dose of the vaccine. Privor-Dumm suggested that the single dose could “make things easier” but “adds more complexity in planning to ensure that people receive the product they need and that health systems can manage the different storage and administration requirements.”
The state is expected to begin its next phase in late January.
“Maryland continues to move forward with vaccine administration in Phase 1A and is ramping up fast, with an average of more than 10,000 vaccine administrations each day,” the Maryland Department of Health spokesperson said.
Rachel Bucchino is a reporter at the National Interest. Her work has appeared in The Washington Post, U.S. News & World Report and The Hill.