I know that the rollout of the vaccine has been chaotic and confusing. Based on news reports and neighborhood rumors, it’s easy to feel frustrated believing other states or counties are doing a better job than us.
The truth is (as usual) more complicated. While there’s plenty of blame to go around, I am focused right now on problem-solving, improved communications, and cooperation between different levels of government. Hopefully, in this email, you find meaningful answers to your questions and not just platitudes and finger-pointing at the other guy. I strongly believe the vaccine rollout is too important to get bogged down in politics as usual: we have to rise above partisan bickering and competition to focus on saving lives.
Vaccine distribution is an enormous undertaking and without a national rollout strategy, each state was left to develop its own system for prioritization and delivery. At the Counties’ request, the state has given each jurisdiction flexibility to determine the priorities that reflect its values and community needs for the distribution of their vaccine allotment through the local health department. However, the state is also simultaneously distributing to entities outside of the health department that follow state rules (not the County rules). This bifurcated system improves access for everyone but creates significant confusion.
The County Says This, But The Governor Says That
(Who Should I Believe?)
Both. They are each speaking from their own perspective. When county leaders describe policies, they are often speaking exclusively about vaccine distribution for the PUBLIC CLINICS, run by the County Health Department. The state has given local health officers significant discretion to have their own policies and rules for their clinics. However, ALL OTHER CLINICS run by the state, including pharmacy partnerships, clinics run directly by the hospitals, and soon to include state-run mega sites, will follow state, not county rules.
It should be noted that this local discretion for Health Department clinics is subject to change. If the tension between County priorities and State priorities becomes too great, the state has levers it can pull to override County authority over vaccines in most cases. If the state gets frustrated enough, it can also reduce or eliminate the County Health Department’s allotment of vaccines, and distribute the same quantity to Montgomery County residents exclusively through pharmacies, hospitals, and mega sites that will follow the state rules. Allowing this to happen would mean a decreased ability to actively promote equity within the vaccine distribution plan. While the state rules do encourage equity considerations, the County rules place a much higher priority on this factor.
This week, the County was turning away individuals who are 75+, in violation of a state order (we were the only jurisdiction to do so). There is still, between the County and the State, confusion about what is left up to County discretion, and what is not. This, of course, creates significant confusion for residents.
Are Maryland and MoCo Getting Their Fair Share? Will We Get More Soon?
Simply put, yes. We are getting our fair share. This CDC webpage shows distribution to all 50 states. You can see that Maryland’s per capita vaccine allocation is within the range of other similar states.
Montgomery County has 16.6% of Maryland’s population. The week of January 11 the County Health Department received only 15.5% of doses distributed by the state to local health departments. After County Officials reached out to the state legislators on this, we were able to increase the allotment from the state. For the week of January 18th (this week) we received a whopping 20.1% of the doses. In other words, way more than our fair share. Based on extremely high demand in the county, we may need to continue to advocate for more than our “fair share." We can only do this if we can make the case that we can comply with state guidelines while running efficient clinics that also promote equity in access. We have to work together to accomplish our common goals.
As for the federal allotment, the Biden Administration has warned us all it will take time to right the ship. Unfortunately, we have been notified not to plan for an increase in our 72,000 weekly allotments anytime soon. We will likely have the same number of doses at the state level delivered weekly until another vaccine is approved. Of course, this is subject to change, but hope is not a plan. We have to work with what we have.
Where are Maryland’s 668,000 Vaccine Doses?
One reason the County-run vaccination clinics got off to such a slow start is that the state overallocated vaccine to the hospitals. At the beginning of this week, 208,000 leftover doses were sitting in hospital freezers. That’s nearly a third of all the doses received by the state! It was an honest mistake, the state delivered the number of doses hospitals requested based on their staffing. Unfortunately, hospitals only had a 30-50% (Hopkins/Suburban is the outlier at 70%) uptake rate among their staff. Many hospital employees are unwilling to get the vaccine at this time. Likewise, many in the 1A category the County Health Department is currently vaccinating, (health care workers outside the hospital or long term care settings) are not making appointments for vaccination. This week, the state required the hospitals to begin distributing their extra 208,000 doses to the public, starting with people 75 and older. Information on these hospital clinics is available on covidvax.maryland.gov, and on individual hospital websites.
In addition to hospitals, private pharmacies (CVS & Walgreens) have also received almost 100,000 doses from the state. These pharmacies are (slowly) going into nursing homes and assisted living facilities to administer vaccinations. This program also got off to a very slow start but is finally ramping up. Unfortunately, residents in Independent Living senior communities (not including Riderwood and Leisure World who have established partnerships with Adventist Healthcare and Medstar Hospital respectively) have been receiving mixed messages from the Maryland Department of Health as to whether their communities will be participating in this problem. I am actively working with the Acting Secretary of Health and Secretary of Aging as well as Senator Van Hollen's office to find a resolution to this problem.
Starting next week, Giant Food and Walmart will receive doses from our federal allocation to begin vaccinating the general public. The state is also in talks with Safeway and Rite Aid to do the same.
In addition, the state intends to eventually send vaccines directly to primary care and other health care providers to vaccinate their patients.
All together, County Health Departments currently receive about 30% of Maryland’s Federal allotment. A lot of the panic and confusion you are hearing is because some Health Departments want a larger share of the vaccine given directly to them. However, the state plan calls for a decreasing number of vaccines to be administered through health departments, and an increase going to pharmacies and other community providers (like doctor’s offices). There is a philosophical difference- who can do it better? County Government or private sector? Obviously, the County Government believes it’s them. The state leadership believes it may be the private sector. That’s the tension right now between the County and the State.
My opinion? It doesn’t matter who is right. Let’s focus on getting vaccines in arms right now. The 75+ population is vulnerable to COVID death, and our responsibility is to get everyone who wants a vaccine vaccinated by working together. For populations who are still unsure of the vaccine, we have a responsibility to hear their concerns, share information, and make sure that if they change their minds, vaccines will be available to them in convenient locations without waitlists. We can do both. But it will be easier if we stop bickering and start working together.
HOW AND WHERE DO I SIGN UP FOR A VACCINE?
There are multiple avenues/venues available to get a vaccine, which can be confusing but is ultimately a good thing because it will allow us to use the vaccines more efficiently and distribute them more quickly. Currently, according to state guidelines, those eligible for vaccines include Priority Groups 1A and 1B:
Health care workers
Residents and staff of nursing homes
First responders, public safety, corrections
Assisted living, independent living
Behavioral health and developmentally disabled group homes
Other congregate facilities
Adults age 75 and older
Education and Child Care Providers
On Monday, January 25, the State will move into 1C, which includes people 65-74 and additional essential workers. Specific details for tiers are here:
If you are a member of any of these groups, here are the various ways you can obtain a vaccine:
Pre-register with Montgomery County Health Department as your first step. They will systematically reach out as vaccines are available. Their clinics have been efficient, but they have a lot of people to serve. There are already 50,000+ people on the pre-registration list, but the county receives only 6-8,000 doses a week. The County is still prioritizing 1A only at the moment, despite the new state rules. If vaccine access is a priority for you, get on the County pre-registration list ASAP. If you do receive an invitation link to make an appointment, DO NOT FORWARD IT to your friends and family, even if they have pre-registered. The County Health Department is being extremely selective about who gets the link, and they have turned away appointments they deem fraudulent, even for people in 1B and 1C.
Hospitals are beginning public clinics. Suburban is prioritizing existing patients within the Hopkins system. If you have a Hopkins "My Chart" account, make sure it is active. If you are with Kaiser Permanente, make sure your kp.org account has the correct contact information. Holy Cross, Adventist, and Medstar have public clinics. Information is available on their websites and at covidvax.maryland.gov. The Montgomery County hospitals are also working to set up a larger site staffed jointly by the different hospitals, so stay tuned. Please note, hospital clinics generally follow state rules, not county policies. Even if Montgomery County remains in 1A, these clinics will serve 1B and 1C as well, prioritizing the 75+ population, as the state ordered.
Giant is offering vaccines to the public starting Monday. Appointments can be made on their website: www.giantfood.com/covid-info on January 25th. The pilot project locations are Georgetown Square, Kentlands, Burtonsville, and East-West Highway in Silver Spring. We expect each location will serve between 30-40 patients a day, so about 1,000 residents a week. They will take appointments for 1A, 1B, and 1C.
The state is in the process of setting up "mega clinics" with the National Guard at Fed Ex Field, M&T Bank Stadium and Morgan State University. These appointments, which will also be offered to 1A, 1B, and 1C, will be available through the state website covidvax.maryland.gov. These clinics, like county clinics, are subject to vaccine availability from the Federal Government.
Please Note: The state estimates 1.5 million people in tiers 1A, 1B, and 1C. That would require 3 million vaccine doses. With an uptake rate of 50%, we would still need 800,000 more doses (at 72,000 a week- about 11 weeks) to vaccinate everyone who wants a vaccine in these priority groups. As hard as it is, we have to remain patient. Equally important, a 50% uptake is not high enough to keep our communities protected. According to Dr. Fauci, we should be aiming for 85% uptake. As counterproductive as it may sound, we need more programs implemented right now to increase uptake among concerned groups, even with vaccine shortages.
Stay updated on the COVID-19 vaccine:
Visit the Maryland Department of Health’s vaccine webpage for the state’s latest vaccine rollout information
- Text MDReady to 898-211 for updates from the Governor’s office
Find information on and sign up for state and hospital run vaccine clinics for 1A, 1B, and 1C: covidvax.maryland.gov
Find information on Giant Pharmacy clinics for 1A, 1B, and 1C: www.giantfood.com/info
Sign up for text/email updates from Montgomery County here
Visit Montgomery County’s vaccine webpage for the county’s latest vaccine rollout information
Sign up for Montgomery County’s “Pre-Registration” list here
View the latest vaccination data in Maryland
Visit the CDC for general information about the vaccine
Stay updated through local news and social media. Policies change several times a week. When I learn new information I share it on Facebook so please follow my page to stay current.
I believe in both the County and State government here in Maryland. I am confident that, despite our differences, we can work together to ensure Marylanders desperate for a vaccine have access in as timely a way as the federal allotment allows. I also believe we can work together to address community concerns about vaccine safety and encourage people to access the vaccine at higher rates as soon as they are comfortable. I look forward to the ongoing work of the Biden Administration’s newly established Health Equity Task Force, which will provide us culturally component recommendations related to hesitancy to take the vaccine.
I know it’s hard. We are all tired and wanted 2021 to bring immediate relief. It’s coming, in the form of a vaccine and a (much) higher functioning federal government. Hold tight. We are almost through.
Stay safe and be well,