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Plan for vaccine prioritizes hospitals, nursing homes

Maryland Gazette - 11/18/2020

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.

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.

Individual Marylanders would receive the vaccines at no cost.

Caption: Dr. Tom Inglesby speaks on Capitol Hill in Washington, D.C., on March 6.

Samuel Corum/TNS

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