Why is West Virginia Doing a Better Job on Vaccination Than Maryland?

By Adam Pagnucco.

William A. Galston, a Senior Fellow at the Brookings Institution, has written an eye-opening piece on vaccine distribution comparing West Virginia to Maryland. In it, Galston notes that West Virginia ranks high on poverty rate, low on education rate and low on median income among U.S. states while Maryland is on the other end on all those measures. Yet, West Virginia “ranks 2nd in the share of its population that has been inoculated and has turned 83% of the doses received from the federal government into actual inoculations” while Maryland “ranks 35th for its inoculation rate and has delivered only 46% of doses received into its people’s arms, well below the national average of 53%.”

What accounts for the disparity?

Galston identifies two factors. First, he credits West Virginia for relying on a network of independent pharmacies to vaccinate nursing home residents rather than using CVS and Walmart, which the rest of the nation has done. Galston believes local pharmacies have more penetration into rural areas and closer relationships with nursing homes than national chains, resulting in better vaccination performance. The second factor has to do with the governance structures used by West Virginia and Maryland. Galston writes:

The second apparent explanation for West Virginia’s superior performance: decisions have been made by the governor at the state level, eliminating confusion and competition among localities. Starting January 25, a state-wide online site will allow all residents to register for vaccinations and will direct them to facilities with doses available. A week later, on February 1st, the state will expand its network of community clinics to cover all 55 of its counties.

In Maryland, by contrast, most of these issues have been left to its counties, each of which has established its own priority lists and facilities for administering the vaccine. Maryland’s system of strong county governance works well in normal times but is impeding vaccine delivery during this pandemic. As Maryland residents know, this diversity has created confusion and has given residents with access to multiple information sources advantages over those with weaker networks and less Internet access. A bewildering maze of online sites—some from counties, others from hospitals–has sprung up. Prince George’s County has closed its vaccination facilities to Marylanders who live outside its borders.

Galston has a point. One cannot overstate the level of confusion in Maryland about how to get vaccinated. Take a look at the state’s vaccine website, which says that we are in Phase 1C, which includes adults age 65-74 and essential workers in lab services, agriculture, manufacturing and the postal service. Now take a look at Montgomery County’s vaccine website, which says we are in Priority Group 1B, which includes adults age 75 and older. Prince George’s County’s site aligns with the state while Anne Arundel County’s site says, “Currently, the Anne Arundel County Department of Health is NOT in Phase 1C. The Department is providing vaccine appointments ONLY to the Phase 1A group and Phase 1B’s county residents who are age 75+.” Frederick County’s site says it is vaccinating “1A and people 75 years and older who live or work in Frederick County.” Baltimore County’s site says it is in Phase 1C. Howard County’s site says that Phase 1C has not begun and vaccinations for adults age 65-74 will begin in February. And so on. Baltimore City’s site seems to resemble the state’s but says that phases are “as of Jan. 25th, 2021. Phases subject to change due to CDC, MDH or FDA updated guidance.” So what’s true now might not be true tomorrow. Add to this the assorted residency and work requirements being imposed by counties and the disarray gets worse.

Then there are the hospitals, who as of last week had received twice as many vaccines as county health departments. Hospitals are responsible for vaccinating their staff and associates but what happens if they have left-over vaccines? I was recently forwarded an email that originated with a doctor at one of MoCo’s hospitals stating that they had a surplus of vaccines and had 16 appointment slots. The email spread like wildfire and the slots promptly filled up. Who knows who signed up? Enthusiasm quickly dried up when the hospital sent notice to those who registered that they had to provide proof of health care employment and had to sign legal attestation of eligibility.

Confusion and multiple opportunities for registration and preregistration have tempted some to sign up at every outlet they can find, reasoning that if just one of them pays off it will be worth it. In a briefing with the media yesterday, Montgomery County officials tried to persuade the public to avoid this practice because it would overbook appointments and clog the system. But with different entities administering vaccines and apparently different criteria and rules in place among them, why wouldn’t folks sign up everywhere they could hoping to get lucky?

The biggest single problem afflicting all states and counties is the nationwide shortage of vaccines, which the Biden administration is trying to fix through buying 200 million more of them. It’s also understandable that Maryland is relying on its existing system of counties and health care providers rather than trying to reinvent it in the middle of a huge vaccination push, which would undoubtedly create a whole other category of problems. But the conflicting information coming out of the state, its 24 local jurisdictions and other vaccine-administering entities is problematic. If it continues, it will hinder the efficiency of vaccine distribution and prolong the pandemic.