Even though no coronavirus vaccine has been approved by regulators and widespread availability is likely months away, health officials are planning for how to vaccinate Marylanders.
In a draft plan submitted to the federal government, Maryland health officials envision a two-phase program that would first vaccinate health care workers and some of the most vulnerable state residents, and eventually turn to the general population once a vaccine becomes widely available.
The plan, released publicly Tuesday, sets out two phases for distribution.
The first phase, when only limited doses might be available, would focus on distributing the vaccine to hospitals, nursing homes and local health departments.
The plan says that “final decisions are still being made” about exactly who would be eligible first for a vaccine. But it identifies candidates to include: health care workers who treat coronavirus patients; essential workers in public safety, education and nursing homes; people at risk of complications due to age or medical conditions; workers and residents of nursing homes and other long-term care facilities; and staff and inmates of prisons and jails.
The state estimates the first phase would include about 14% of Maryland residents, though it’s still working on an exact tally.
The goal is to get the initial doses to people in way that will reduce serious illness and deaths until the vaccine is more widely available.
“We really want to make sure that we can minimize the effect of COVID-19 on those that would be at higher risk of complications,” said Kurt Seetoo, chief of the Maryland Department of Health’s Center for Immunization.
The second phase, when more doses are available, would target the general population. The state is recruiting doctors, pharmacists and other health care providers to give those doses to people.
The state would move into the second phase based on vaccine availability and how many people in the first phase have been vaccinated.
Some details about the costs and the logistics of shepherding people into the right priority groups, were absent from the framework, public health experts said after reviewing it.
The state’s prioritization plans seem “reasonable, but broad,” said Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security. He said states should anticipate receiving fewer allocations of vaccines than expected, and might need a vetting system for vaccine recipients.
“How do you figure out which people are in one category or not? Is there documentation required? Is it basically how people self-identify?” asked Inglesby, who advises Republican Gov. Larry Hogan as part of the state’s coronavirus task force but did not contribute directly to this draft.
Since the pandemic reached Maryland in March, more than 136,000 Marylanders have tested positive and 3,904 people have died. As of Tuesday, there were 464 people in the hospital with the virus, a number that’s been increasing since Sept. 20.
The federal government’s Operation Warp Speed has put billions of tax dollars into vaccine development with the goal of eventually producing at least 300 million doses of an effective vaccine. It has a January goal for making the initial doses available. Multiple companies are working on potential vaccines.
In Maryland, vaccines would be administered by a combination of providers, including hospitals, local health officers, doctors in private practice and pharmacists.
A state incident commander will oversee the program, which will be run through the state health department’s Center for Immunization, with help from numerous state agencies.
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10 19 2020 Maryland COVID 19 Vaccination Plan CDCwm (PDF)
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At least three computer systems will be used to manage the program, including one that will ask people to preregister for the vaccine once one is available. That will help the state collect information, such as how many people are eligible in each phase and where they live, that can help decide where to open vaccination sites. Such information also will be used for communications efforts and letting individuals know when and where they can get a shot.
Inglesby noted that the state should ensure that people lacking access to health care and transportation can get to distribution sites easily.
“There can’t be ‘vaccine deserts,'” he said.
The effort will use an existing online database, called ImmuNet, to track vaccine orders and doses administered. An online service will manage appointments and send people reminders to get second doses, if those are needed.
A public dashboard will show data on vaccinations.
The state plans to hire a “marketing vendor” to help with outreach, which will focus on the safety of the vaccine and when individuals can get it. The state also plans to “coordinate with trusted community partners, priority group representatives, and representatives of vulnerable populations” to get the word out.
“With the rapid development and licensing of COVID-19 vaccines, there will be concerns as to the safety and efficacy of the vaccine,” the report notes. “Messaging will need to instill confidence in the vaccine and describe the process for reporting vaccine adverse events.”
A recent Goucher College Poll found Maryland respondents split on taking a vaccine. The poll asked people whether they would take an FDA-approved vaccine. Forty-nine percent said they would not, while 48% said they would take the vaccine.
Seetoo said lack of public confidence in the vaccine is the biggest challenge he sees. Maryland plans to set up a panel of experts to review the safety and efficacy of any vaccines to be used here.
A goal. he said, will be “making sure that we really educate people and really get them confident in the vaccine and knowing that the vaccine offered is going to be safe and effective.”
The draft plan discusses how the state’s outreach efforts must be “sensitive to social and cultural nuances of Marylanders.” It also states that “equity” should be considered in distributing the vaccine.
But it does not call for making vaccination a higher priority for groups of people who have suffered disproportionately from the coronavirus, such as Black and Hispanic residents.
Of the state’s coronavirus cases where race data is available, African American residents make up nearly 37% of cases, though they only are 31% of the state’s total population. Hispanic residents are 11% of the state’s population but 25% of coronavirus cases, according to state data.
Dr. Tumaini Rucker Coker, director of research at Seattle Children’s Hospital’s Center for Diversity & Health Equity, said health care interventions have to emphasize disadvantaged populations first — rather than adapt neutral plans — to suit at-risk populations.
“We create things for the advantaged, for people who have access to primary care or transportation, can take time off work during business hours and who have health literacy,” said Coker, who is also an associate professor of pediatrics at University of Washington School of Medicine. “If we want to reduce disparities, all the plans and processes should be designed with the most underserved populations in mind.”
Seetoo said the state placed groups into each phase based on a list from the National Academies of Sciences, Engineering and Medicine. The phases will be updated when a federal group called the Advisory Committee on Immunization Practices comes out with its recommendations.
“Once that plan comes out, our plan will probably change,” Seetoo said.
It’s not known how much it will cost the state and local governments to run the vaccination program. The state received about $4 million in federal grant money to help with planning and logistics.
The state is counting on the federal government to provide everything that’s needed to administer the doses in 100-dose kits, including needles, syringes, alcohol pads, protective equipment and vaccination record cards for patients.
Individual Marylanders would receive the vaccines at no cost.
State health officials started discussing logistics in April, and have added experts from other agencies as plans took shape. The plan will have more revisions as a vaccine gets closer to delivery.
“Our plan will continue to evolve — but our focus will always be on the safety and efficacy of the COVID-19 vaccine to prevent the spread of the disease among Marylanders,” said Dr. Jinlene Chan, acting state deputy secretary for public health, in a statement.
With many unknowns about a potential vaccine, Maryland officials worked several assumptions into their plan, including: The vaccines may need to be kept in extremely cold storage, two doses may be required, and limited initial supplies of the vaccine should go to high-risk groups first.
Maryland is working on a “confidential database” of locations that have ultracold storage capabilities. The plan notes training will need to be provided to vaccinators on how to keep doses at the proper temperature.
