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.

By Adam Pagnucco.

COVID vaccine distribution is a hot issue in Maryland. COVID case rates have spiked since October and death rates are at their highest levels since the spring. Elected officials’ inboxes are filling up with inquiries from residents and the press is paying attention. Lots of folks are looking to their local governments but the vaccines are delivered by the state. How is the state doing?

Vaccine distribution in the U.S. is a multi-tier process. Pfizer and Moderna manufacture the vaccines. The federal government determines their allocations to states. (You can see open data on distribution of both the Pfizer and Moderna vaccines by state.) State governments then distribute the vaccines they receive to their local jurisdictions.

Maryland has established a three-phase hierarchy for determining the order in which groups receive vaccines. The state has progressed through Phase 1A (health care workers, residents and staff of nursing homes and first responders, public safety, and corrections staff) and is now in Phase 1B (assisted living, independent living, behavioral health and developmentally disabled group homes, and other congregate facilities; adults age 75 and older; and education and continuity of government). Further phases will expand to larger populations.

The state is currently distributing vaccines primarily to three different kinds of entities. Hospitals, who are expected to vaccinate their own staff members and associates, received 320,200 vaccines as of 1/18/21. Pharmacies, including CVS and Walgreens, are responsible for vaccinating nursing homes and received 73,125 vaccines as of 1/18/21. Local health departments are responsible for vaccinating other people in Phases 1A and 1B, especially health workers and first responders, and received 137,425 vaccines as of 1/18/21. Other agencies, including the National Institutes of Health, the D.C. Department of Health and a few state agencies, received another 20,950 vaccines.

And so the counties, hospitals and pharmacies don’t control how many vaccines they get. They do control the rates at which they administer vaccines to residents. As of 1/18/21, vaccine administration percentages were 61% for local health departments, 40% for hospitals, 39% for pharmacies and 69% for other agencies.

The table below shows administration rates by county health department. Queen Anne’s, St. Mary’s and Montgomery counties have all administered more than 90% of the vaccines they received from the state as of 1/18/21, the best in Maryland. Baltimore City and Charles, Prince George’s, Somerset and Washington counties have administered less than 30% of the vaccines they received as of 1/18/21.

Administration rate is one factor in vaccinating a population. The other factor is deliveries relative to population. It’s hard to know the location of residents being vaccinated by hospitals and pharmacies. However, local health departments are presumably vaccinating residents who live (or at least work) mostly within their jurisdictional boundaries. The table below compares vaccination deliveries to local health departments with U.S. Census estimates of their populations in 2015-2019.

There are large discrepancies in the state’s delivery of vaccines to local health departments on a per capita basis. Relative to their populations, Kent, Somerset, Garrett, Talbot and Caroline counties – each having less than 40,000 residents – received the most vaccines, varying from 4.5 to 8.2 per hundred residents. Montgomery County (1.9 vaccines per hundred residents) and Prince George’s County (1.6 vaccines per hundred residents) are at the bottom. Baltimore County and Baltimore City are also below the state average delivery rate per capita.

A county with an excellent vaccine administration percentage but a low delivery rate from the state could wind up with a low vaccination percentage of its population. In fact, that’s what the table below shows for Montgomery County. Despite having one of the best administration percentages in the state, MoCo is below average on the percentage of its population receiving a first and second shot because of its low per capita delivery rate.

It’s still an early moment in the state’s vaccination program. There is time to improve. But there is also a role for elected officials who represent counties with low vaccine delivery rates and their constituents to press the state to do better.

By Adam Pagnucco.

Last night, Montgomery County Government sent out a blast email claiming, “Montgomery County is has [sic] taken swift steps to administer the vaccines it has received—proceeding at one of the highest rates of vaccine administration in Maryland.” The same claim is repeated on the county’s website.

Is this true?

The county doesn’t elaborate on this claim in great detail but it has support from the slide below from its Department of Health and Human Services. The slide shows the percentage of received vaccines that has been administered by each county in the state. As of January 13, MoCo administered 63% of the vaccines it has received, trailing only Caroline County (68%) and far above the state average (36%).

However, the county trails badly on another key measure: the percentage of population vaccinated. Another slide from the same presentation shows that just 2.2% of MoCo’s population has been vaccinated with at least one dose, a rate that trails 20 of the state’s 24 jurisdictions.

To be fair, MoCo doesn’t have full control of its population vaccination rate because the state allocates vaccines by county. At this point, Baltimore County has received more vaccines than MoCo even though its population is smaller.

County Executive Marc Elrich has posted a good explanation of the complications in distributing vaccines, especially the role played by the need to vaccinate people twice. It’s very informative for folks who would like to understand how the process works and what bottlenecks lie within.

In any event, by one measure, the county is exceeding the state’s vaccination rate and by another, it is falling short. The story is a complex one and, at this point, not reducible to emailed success stories.