Van Hollen, Brown Lead Maryland Delegation Calling for a Course Correction to Maryland’s Vaccine Distribution Approach

U.S. Senator Chris Van Hollen and U.S. Congressman Anthony G. Brown led Maryland delegation members Senator Ben Cardin and Reps. Steny Hoyer, Dutch Ruppersberger, John Sarbanes, Kweisi Mfume, Jamie Raskin and David Trone (all D-MD) in a letter to Governor Larry Hogan calling for his Administration to reform and improve vaccine distribution by adopting best practices from other states around the country. Maryland has consistently ranked in the bottom tier of states for vaccine distributions due to an ineffectual, fragmented approach. The members maintain a course correction is needed and requested that the Governor answer a series of questions addressing their specific concerns.

In the early stages of vaccine rollout, Maryland was ranked 50th – last among states in terms of the percentage of shots administered. As of writing this letter, Maryland is ranked 41st on that metric. Black Marylanders have received about 16 percent of first doses. Yet they account for approximately 35 percent of COVID-19 deaths and make up 31 percent of the state’s population. The Brookings Institution identified Maryland’s decentralized approach as delaying an effective vaccine rollout. 

“The lack of state-wide coordination and communication in Maryland’s vaccine program has yielded rampant confusion and a disjointed, inequitable roll out,” the members wrote. “It is clear that the State is not meeting the needs of Marylanders, and we urge you to put forth a strategy and clear guidance that significantly improves Maryland’s vaccination program.” 

Members highlighted the lack of clear public guidance, coordination with local leaders and absence of a streamlined process as hampering Marylanders’ ability to get vaccinated. Residents are required to register multiple times but don’t know their place in line, are unable to set up appointments or have had their scheduled ones unexpectedly cancelled. Seniors and educators are unclear if they qualify for a vaccine and do not know where they can get one. Meanwhile, vaccine allocations to county health departments, responsible for vaccine distribution, have been cut.

The members continued, “These issues must be addressed immediately. It is critical that the state put forward a strategy that addresses the glaringly apparent disparities in vaccine access and increases equitable vaccine administration to minority communities. Your health officials can increase efficiency by working collaboratively with local jurisdictions to ensure efforts are coordinated and that they have the resources needed to triage vaccine traffic efficiently. Leaving localities to fend for themselves and compete amongst each other is counterproductive.”

The members urged Governor Hogan to establish a one-stop website for online appointment booking, similar to other states’ systems.

Read the full letter below.

Dear Governor Hogan:

We write to you today regarding the current status of Maryland’s vaccination strategy. Across the state, Marylanders eligible for the vaccine are unable to schedule their appointments and do not know when, where, and by whom they can get vaccinated, leaving people and communities extremely frustrated. It is clear that the State is not meeting the needs of Marylanders, and we urge you to put forth a strategy and clear guidance that significantly improves Maryland’s vaccination program. 

Since the early stages of the pandemic, public health officials have maintained that widespread immunity via mass vaccination campaigns would be the most effective path to defeating COVID-19 and returning to pre-pandemic life. We have long expected that launching the most ambitious vaccination operation in our nation’s history would present many challenges: grappling with initial limited vaccine supply, prioritizing vulnerable populations, combating vaccine hesitancy, coordinating with local jurisdictions, communicating accessibility, reaching hard-to-reach communities, and ensuring vaccination equity among communities of color. We appreciate how difficult these decisions and obstacles are, many of which have unfairly fallen on state and local governments to solve.

Due to actions by the Trump administration, state governments are responsible for spearheading the robust vaccination programs needed to extend immunity across the nation. Such a vaccination strategy is critical to our efforts here in Maryland. Yet, Maryland has been falling far short. In the early stages of vaccine rollout, Maryland was ranked 50th—last among states in terms of the percentage of shots administered. As of writing this letter, Maryland is ranked 41st on that metric and we are concerned about the State’s lack of guidance provided to health providers, hospitals, and county health departments. A course correction is needed. 

Congress has recognized the constraints states face when scaling up a large vaccination program and last month passed a COVID-19 relief package that included $19 billion to boost vaccine manufacturing and purchasing and $8.75 billion for vaccine distribution, administration, and monitoring. To be sure, much more support is needed, and the Biden stimulus plan includes $160 billion for vaccine and testing efforts, as well as robust funding for state and local governments. In addition, President Biden announced last week that the federal government will purchase 200 million additional doses and increase states’ allocation of vaccines by 16%. We are pleased that the Biden stimulus plan includes $160 billion for vaccine and testing efforts, as well as robust funding for state and local governments. Even with robust support from the federal government, we remain concerned that the State will be strained to efficiently deploy Maryland’s higher allocation, such as targeting doses to areas of the state with higher rates of infection. Simply opening up new phases when supply will continue to be limited in the near future amplifies the high demand and logistical challenges that Marylanders are already experiencing. 

We are hearing every day from constituents and local officials expressing immense frustration and confusion with the program’s inefficiency and inequity. Marylanders that fall in phases 1A-C have been told by the Maryland Department of Health (MDH) that they are eligible to receive the vaccine. Yet, MDH has not released clear directions, nor created a streamlined process needed for Marylanders to actually get a vaccine.  More often than not, eligible Marylanders are unable to set up appointments or have had their scheduled ones unexpectedly cancelled. Individuals who are housed or work outside of easily leveraged health care infrastructure—such as self-sufficient seniors—do not know where they should go to get their vaccinations. And schools have been directed to reopen, but educators are unable to find an appointment or location where they can get the vaccine. 

Due to the lack of a simple and centralized process, local health departments are grappling with an influx of residents trying to receive a vaccine from a county in which they do not reside or work. This further exacerbates the disparities in vaccine access that demographic data is already demonstrating: Maryland is immunizing communities of color at significantly lower rates. Black Marylanders have received about 16 percent of first doses. Yet they account for approximately 35 percent of COVID-19 deaths and make up 31 percent of the state’s population. In the absence of a clearly communicated vaccine strategy, guidance, and transparency, the state's vaccination program is failing Marylanders. 

These issues must be addressed immediately. It is critical that the state put forward a strategy that addresses the glaringly apparent disparities in vaccine access and increases equitable vaccine administration to minority communities. Your health officials can increase efficiency by working collaboratively with local jurisdictions to ensure efforts are coordinated and that they have the resources needed to triage vaccine traffic efficiently. Leaving localities to fend for themselves and compete amongst each other is counterproductive. Additionally, MDH must work to provide clear, accessible information and simplify the vaccination process. Similar to other states’ systems, we urge you to establish a one-stop website for online appointment booking and a call center to schedule vaccinations for those with limited Internet access—a common problem among seniors. As the State increases locations for vaccine administration that apply different eligibility criteria, too many people do not know where or how they can get vaccinated. This fragmented approach is just not working. A centralized registration website and call center is critical for reducing uncertainty. 

We are seeking answers to the following questions:

1. The state previously conveyed that providers may face reduced doses if they fail to administer over 75% of received doses. Yet, certain county health departments have faced a reduction in weekly supply in light of the state’s new private partnerships with Giant and Walmart, despite performing above this benchmark. County health departments play a crucial role in ensuring equitable access to vaccinations. How does the State intend to keep its commitment not to reduce allocations to County health departments that have met their targets? How much of the County and City health departments’ allocations have been re-channeled into distributions to hospitals and private partnerships?
2. Counties need a reliable source of vaccines to allow for proper planning and administration of second doses. The federal government announced that it will provide states with three weeks’ advance notice of their estimated vaccine allocation to help states with their planning. How will the Governor’s office improve communication to counties regarding how many vaccines the state is receiving each week and how many of those will flow to the local jurisdictions each week?
3. How will the State-run mass vaccination sites coordinate with the county health departments to avoid confusion and maximize the doses provided by the federal government?
4. The state has opened up vaccine eligibility to Marylanders in Phases 1A, 1B, and 1C, which represent over two million Marylanders. Thus, the state will need four million doses of two-dose vaccines to complete Phase 1. Yet, the total supply Maryland has received to date is 852,625. If the state continues to receive about 10,000 doses a day and all eligible Marylanders opted to get a vaccine, we will still face a shortfall of 2.8 million doses in four weeks. In many cases, seniors in Phase 1B are struggling to get the vaccine at hospitals or through pharmacies, while individuals in subsequent priority groups can. Counties have applied a tiered system where certain groups in 1A, B, and C are eligible and others are not. In light of persistent confusion across counties and limited supply, does the state intend to issue statewide guidance specifying the order in which vaccines should be administered among priority groups?
5. How is the state planning to use the $402.6 million in federal relief dollars provided for COVID-19 distribution, testing, tracing, and mitigation? Please provide a detailed breakdown of how these public funds will be used.
6. Marylanders would benefit from increased transparency at every level of the vaccine rollout process. Can you provide the contracts between the State and any private sector partners engaged in these efforts?

The lack of state-wide coordination and communication in Maryland’s vaccine program has yielded rampant confusion and a disjointed, inequitable roll out. It is imperative we stop issuing sweeping directives without giving county health departments, local jurisdictions, and educators the tools they need to implement an effective vaccination program. We must give county health departments, local jurisdictions, educators, and vaccine eligible Marylanders the tools they need to implement an effective vaccination program. We look forward to continuing to work with you to address the needs of all Marylanders  

Sincerely,