Maryland's problems as illustration of difficulties in smooth vaccination rollout

UPPER MARLBORO, Md. — The path to quickly vaccinating the nation’s 250 million adults will be paved with pharmacy chains, hospitals and hulking stadiums where uniformed troops help inoculate thousands of people a day.

But it will also rely on the recreation center at the First Baptist Church of Glenarden here, along with tiny storefront service organizations and vaccine-stocked vans that scour neighborhoods for the unprotected.

Maryland offers a microcosm of the issues states face as they rush to open enough vaccination sites to meet President Biden’s goal of making every adult eligible for Covid-19 shots by May 1. It has encountered nearly all the geographic, demographic and human behavioral challenges that come with a public health task of this scale.

It has poor urban neighborhoods where many people lack access to regular care; wealthy Washington suburbs whose residents have proved adept at vacuuming up shots meant for other ZIP codes; isolated rural areas; and a sign-up system that has so vexed the citizenry that vaccine hunting has become for many a part-time job. ...

Nearly every state in the nation now finds itself in a perilous race between vaccinating its residents and succumbing to an onerous wave of cases fueled partly by the emergence of new variants of the coronavirus. As states rush to expand eligibility for the shot, many are also loosening rules on dining, gathering and masks.

It will take extensive group efforts across competing interests to push states closer to herd immunity. Efforts to track who is getting vaccinated, and where, will become all the more important so that health officials can quickly identify who is being left behind, and shift their strategies and resources accordingly.

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

“It really is going to be the start of much more surveillance and analysis being needed to make sure that this was both a fast and a fair rollout of the largest vaccination campaign in human history,” said Alison M. Buttenheim, an associate professor at the University of Pennsylvania School of Nursing.

Here in Maryland, the pent-up demand for the vaccine is huge: only people 65 and older, some types of essential workers and a few other narrow categories were eligible until late March, leaving two-thirds of the population still unprotected. ...