Maryland health department using county ‘compliance’ and ‘efficiency’ to allocate COVID vaccine doses

While Maryland has said it’s allocating the COVID-19 vaccines to counties based on population, state health officials notified counties this week that the state can distribute doses based on how well the counties “comply” with state directives and how efficiently they can get shot into arms.

The notification was included in a letter Maryland’s acting health secretary sent Tuesday to county leaders in response to a letter the Maryland Association of Counties sent Monday to Gov. Larry Hogan.

It was not immediately clear which counties, if any, have benefited or been sanctioned as a result of that caveat. The Maryland Department of Health has not made public data on how it is allocating the vaccines to local jurisdictions despite multiple requests from The Baltimore Sun.

“Maryland’s goal is to provide each geographic jurisdiction with a percentage share of doses by jurisdiction, with adjustments for providers who are efficient at vaccine administration and who comply with the state’s vaccine priority directives,” wrote Dennis R. Schrader, the state’s acting health secretary, in the letter addressed to the heads of the Maryland Association of Counties.

In an email Wednesday, Maryland Department of Health spokesman Charles Gischlar added that the allotment to county health departments makes up a portion of each county’s total allocation, and does not include vaccine doses distributed to hospitals, retail partners, mass vaccination sites or pharmacies.

The state has established minimum allocations ranging from 300 to 975 doses for each county health department depending on population.

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But some county health officials say that their weekly allotments, especially in recent weeks, have fluctuated at the expense of the state’s most vulnerable populations, which local departments say they may be best suited to reach.

And some municipal leaders complain they are not receiving enough doses to adequately address the competing demands of seniors, educators and some essential workers, all of whom are eligible for vaccination.

“The lack of clear information coming from the State is driving an inequitable distribution of vaccine right now,” Baltimore Mayor Brandon Scott said in a statement Wednesday. “Not being open and transparent about where all of the doses are going on a regular basis means we cannot make effective decisions around how to rapidly and equitably vaccinate our residents.”

Frustrated with the supply problems, Scott went so far as to offer to buy vaccines directly from Johnson & Johnson, which is seeking a federal emergency use authorization for a vaccine it is having manufactured in Baltimore.

Dr. Larry Polsky, Calvert County’s health officer, aired his concerns on social media Monday, noting that the jurisdiction’s weekly allocation had dropped 66% the week of Feb. 1.

Noting that the county has a waiting list of at least 1,500 older adults waiting to get vaccinated, Polsky said in an interview that if the allotment were based on per capita considerations alone, Calvert would get 1,110 doses per week. Instead, it got as few as 500 for the week, with little explanation as to where extra doses went instead.

“Right now, where we have an enormous shortage of vaccine, herd immunity is not realistic,” Polsky said. “We need to get the vaccine to people who are most susceptible and have a greater risk of dying. That’s something that is best done on the local level.”

In Schrader’s letter, he said the newly opened mass vaccination site in Prince George’s County has attracted residents from 22 of Maryland’s 24 jurisdictions.

But Polsky said many Calvert residents live in rural areas, far from the mass vaccination sites, pharmacies and retail partners, making it all the more crucial for weekly allocations to counties to remain consistent for now.

The state health department’s mass vaccination strategy hinges on local health departments’ ability to help immunize people eligible for vaccines in the initial phase of the rollout. Their role is expected to diminish as more sites come online and as more people qualify for vaccines.

But with limited national vaccine supply, the state has been unable to allocate as many doses to health departments as requested.

“Recently, local health departments collectively submitted requests for more than 94,000 doses, a collective request far exceeding the total allocation the state receives from the federal administration,” Schrader said in the letter. “Certain individual jurisdictions have requested as many as 20,000 vaccines in a single week alone — a request that would be impossible to fulfill given our allocation from the federal administration.”

The pressure on states to vaccinate their residents has increased as the coronavirus pandemic maintains its deadly grip. COVID-19 has killed more than 470,000 Americans, including 7,267 in Maryland as of Wednesday, and new, more contagious variants of the virus currently circulating threaten to push those numbers upward.

Some states have administered vaccines more efficiently than others.

Maryland ranked 41st of 50 states and Washington, D.C., Wednesday for the number of vaccine doses administered per 100,000 residents, according to an analysis of data collated by the U.S. Centers for Disease Control and Prevention. That’s the same place it ranked Jan. 27.

It did improve in its ranking for the number of people fully vaccinated per 100,000 residents, jumping to 37th Wednesday from 47th two weeks ago.

Health officials in Maryland say the CDC data lags behind state data. State health department data shows Maryland has administered almost 31,000 more doses than the CDC’s numbers, despite both being updated Wednesday. But even with Maryland’s apparently more up-to-date accounting, the state still slots into the bottom half.

Using the health department data, Maryland would rank 35th for vaccine doses administered per 100,00 residents and 28th for the number of people fully vaccinated per 100,000 residents.

According to Schrader, governors have raised CDC data issues on calls with the federal officials, making statewide comparisons murky at best.

In their letter, county officials called on the state to revise some functions of its sluggish vaccine rollout, including increased transparency about allocations for all vaccine providers, prioritizing local health department allocation requests and straightening out the state’s disorganized sign-up process for immunizations.

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The county leaders asked the state to create a statewide site to book appointments, or to allow the counties to use the sites they’ve built to book appointments for hospital and pharmacy clinics.

As currently constituted, those who want their shots have to sign up with various providers for a potential vaccine appointment.

After being questioned extensively by state senators about the lack of a central site Monday, Schrader would not budge on the issue. He said using just one website could lead to catastrophe if it crashed and said the current system was efficient for getting shots into arms.

“There’s a very high risk of creating a single point of failure,” Schrader said.

His answer didn’t satisfy some, including Sen. Clarence Lam, a Democrat and a physician who represents parts of Baltimore and Howard counties.

“We don’t really want a game of ‘The Hunger Games’ going on to try to get an appointment,” Lam said.