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As the nation speeds up to immunize everyone, Maryland’s Path shows the challenges ahead

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UPPER MARLBORO, Md. – The road to rapidly vaccinating the nation’s 250 million adults will be paved with drugstore chains, hospitals and towering stadiums where uniformed troops help immunize thousands of people a day.

But it will also rely on the recreation center of the first Baptist Church in Glenarden. here, as well as tiny storefront service organizations and vaccine-filled vans that scour neighborhoods in search of unprotected people.

Maryland offers a microcosm of the problems states face as they rush to open enough vaccination sites to meet President Biden’s goal of making every adult eligible for Covid-19 injections by the 1st. may. be accompanied by a public health mission of this magnitude: poor urban neighborhoods where many do not have access to regular care; the affluent suburbs of Washington, whose residents have proven adept at sucking shots intended for other zip codes; isolated rural areas; and a registration system that has upset citizens so much that the hunt for vaccines has become a part-time job for many.

“We’re going to push, but we’re also going to have to pull,” said Dennis Schrader, the acting health secretary for Maryland, outlining the state’s plan to not only increase the capacity of mega-sites and drugstores , but also to “attract people” with smaller and more focused efforts.

Almost every state in the country now finds itself in a perilous race between vaccinating its residents and succumbing to an expensive wave of cases fueled in part by the emergence of new variants of the coronavirus. As states rush to expand their shooting eligibility, many are also relaxing the rules on meals, gatherings and masks.

It will take big group efforts across competing interests to push states closer to collective immunity. Efforts to know who gets vaccinated and where will become all the more important as health officials can quickly identify who is being left behind and adjust their strategies and resources accordingly.

Many states have already opened vaccination to all adults, including more than a dozen this week alone. To move the process forward, Biden on Thursday announced a new promotional campaign aimed at communities where vaccine reluctance remains high.

“This is really going to be the start of much more surveillance and analysis needed to ensure this is both a swift and equitable roll out of the biggest vaccination campaign in history.” human, ”said Alison M. Buttenheim, associate professor in the School of Nursing at the University of Pennsylvania.

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Here in Maryland, pent-up demand for the vaccine is huge: only people 65 and older, certain types of essential workers, and a few other narrow categories were eligible until the end of March, leaving two-thirds of the population still without protection.

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On Tuesday, Gov. Larry Hogan, a Republican, opened vaccination to anyone 16 years of age or older who has certain medical conditions; by April 27, all people 16 years of age and over will be eligible, regardless of their medical condition.

But while Mr Hogan has faced stiff criticism from local leaders over the state’s intermediate pace, some people now fear that it is accelerating too quickly. Mr Hogan has previously been criticized for not doing enough to reach black and Latino residents, who make up more than 40 percent of the state’s population, but only 28 percent of those who have received at least one injection .

The Hogan administration plans to open four more mass vaccination sites by the end of April, bringing the total to 12, and has 320 pharmacies administering injections; a federally run site will open at a suburban metro station next week. Hogan’s goal is to give 100,000 injections a day by May, compared to an average of 57,000 a day now.

The state has started adding primary care physicians to the effort, with a goal of having 400 practices administering injections by May. It also works with local health services and community partners, especially churches, to open ‘pop-up’ vaccination sites for populations who may be geographically or socially isolated, or wary of government and large institutions. .

Pastor John Jenkins of Glenarden First Baptist Church understood the role his church could play as he walked down a main street in Prince George County – a predominantly black region that has had high Covid infection rates , but low vaccine rates – after the snake. line of cars leading to a mass vaccination site at Six Flags theme park.

“The people in these cars didn’t look like the people of the county,” said Pastor Jenkins. “The members of this community could not get an appointment.”

With the help of his church’s longtime partner, the University of Maryland Capital Region Health, he quickly established pop-up vaccination sites with his army of church volunteers. State officials, who were providing contract workers, came to see his sprawling indoor recreation center and quickly agreed to dramatically develop his initial dreams of several hundred hits per week.

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The site, which functions as a medical center, planned to vaccinate a few hundred people a day, but quickly grew closer to 1,000 with residents like Denise Evans, who said she felt “more comfortable” in her church. than at the stadium down the street. . The church will soon ramp up to provide daily shots. “I am grateful to the governor for reallocating resources here,” said Pastor Jenkins.

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Targeting smaller populations may also require special efforts. A group of Latin American residents of Baltimore, who were assigned 25 seats at a state convention center, were often unable to reach the site, and those who made it could not find anyone who spoke spanish. The Baltimore Esperanza Center, a unit of Baltimore Catholic Charities, was approached in February by the National Guard to set up a clinic for this group with Johns Hopkins at the Church of the Sacred Heart of Jesus.

“What was really important to us was that they weren’t wearing the uniform,” said Katherine Phillips, the centre’s medical director. (Many of those who attend church are undocumented immigrants.)

The site uses a hotline to help residents get appointments and offers photos of its church on Friday evenings, when more area residents who might not otherwise be able to leave their jobs can attend.

Another point of criticism in Maryland, as in many other states, has been the appointment scheduling system for vaccines. Instead of a single online portal where people can view appointments available statewide, each provider has their own online appointment system, which means people often have to browse multiple sites. to find a niche. The state recently created a unique online platform where residents can pre-register for an appointment at one of its mass vaccination sites, but Mr. Schrader, the acting health secretary, has said the hospital systems and drugstore chains running most of the sites “want to use theirs.” system.”

Dr Josh Sharfstein, associate dean of the Johns Hopkins Bloomberg School of Public Health in Baltimore and former Maryland health secretary, said he expected this approach to prove more problematic as more and more more people are looking for dates.

“This chaotic system where people have to access 15 websites, it really discriminates against people who don’t have computers or who can’t spend all day doing this,” said Dr Sharfstein.

Mr Biden recently said his administration would make it easier to find vaccine appointments, including creating a federally backed website that will show people the places near them where vaccines are given and a toll-free telephone line that people can call for assistance. find a vaccine, both by May 1. He also pledged to deploy “tech teams” to states that need help improving their vaccine appointment portals.

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To date, Maryland has sent about 30% of its weekly vaccine allocation to its mass sites, 30% to local health departments, which share with community groups and other small providers, and the rest to hospital systems. , pharmacies and independent doctors’ offices. .

Going forward, Mr Schrader said the state would rely heavily on local health services and community health centers, which provide primary care to low-income and uninsured people in 126 locations across the state and receive their own allocation directly from the federal government. Among other things, they will be able to compare their patient lists with the state’s vaccine registry to determine who still needs a vaccine.

In Baltimore, where 21% of residents live below the poverty line, local hospitals, pharmacies and a nursing school have teamed up with the city’s health department to send teams at least six times a week to clinics. public housing for the elderly, immunizing more than 2,300 people. there so far. The city will soon expand the program to other high-risk populations, said Dr Letitia Dzirasa, the city’s health commissioner.

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“It’s a little scary to think in a month that it will be fully open,” Dr Dzirasa said.

Still, she and other local state officials said they did not expect a shortage of vaccinators or sites where people could come to be vaccinated. In Washington County, where vast tracts of rural land border Pennsylvania, Virginia and West Virginia, Maulik S. Joshi, president and CEO of Meritus Health, the local hospital system, said that between the Department of County Health, the local committee on aging and his staff of nearly 3,000, he was not worried about staffing or the number of balloons eligible for the vaccine.

“We have deployed people like you wouldn’t believe,” Dr Joshi said as he prepared to open a mass vaccination site in a shopping mall near a highway in Hagerstown, once an outpost of cheap merino wool sweaters and Orange Julius, now part of the medical center. “People from finance and outpatient rehabilitation manage our vaccination sites. We hire. We are ready to go. It’s not a cost or personnel issue for us, it’s just a vaccine issue. “

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