Pictured are Moderna COVID-19 vaccine doses from the initial 100 delivered to Montgomery County officials on Dec. 23. Credit: Photo from Montgomery County

As the COVID-19 vaccine rolls out across Montgomery County and Maryland, many residents have felt left in the dark and confused by the differences in the rollouts among jurisdictions and states, perceiving a slow rollout.

But county and state officials have said they are doing the best they can . County officials have said they depend on the state to provide enough vaccine doses, and it has not been enough. State officials have called on the federal government to release more doses for distribution.

With Maryland, Montgomery County, and other jurisdictions and states in different rollout phases, it can be difficult to know what information to follow.

Here are questions and answers on how the COVID-19 vaccine is being distributed in the county.

Who can currently get the vaccine?

Montgomery County is in Phase 1A of its COVID-19 vaccine rollout and has up to 60,000 people eligible for the priority group. There are currently two vaccines — from Pfizer and Moderna — that are federally approved. Both are two-dose vaccines and must be administered with three to four weeks between doses.

The vaccine distribution is being completed in three phases. Each phase has priority groups, and groups have priority tiers.

In Phase 1A of the county’s rollout, the phase is split into three tiers and the county has been working its way through those tiers.

Appointments are opened for each group. If the appointments aren’t being filled, county officials move onto the next group to keep distribution rolling.

There are no current vaccines approved for children under 16 years old, but vaccine clinical trials are in process for the age group.

Here are the currently eligible tiers in Phase 1A:

Tier 1:
● Hospital personnel
● Long-term care facilities (employees and residents)
● Developmental Disability Administration group homes (those who are not in group homes and cannot receive a vaccine from a pharmacy can receive one from the county)
● Assisted living facilities
● Residential rehabilitation programs

Tier 2:
● Vaccinators (local health departments, school nurses, etc.)
● Testing sites — testers and onsite registration staff members
● Public health — COVID response employees
● Urgent care providers
● Primary care providers

Tier 3:
● Detention centers staff members
● Law enforcement (patrol and employees working with the public)
● Fire rescue
● 911 dispatchers

These remaining groups in Tier 3 are eligible for vaccinations starting this week and are being registered for appointments:
● Dental practices
● Pharmacists
● Other health care professionals (outpatient specialties, optometrists, physical therapists, podiatrists, community health workers, in-home nursing staff, etc.)
● Homeless shelters staff members
● Behavioral health providers
● School nurses
● Lab workers
● Funeral home staff members
● Surgical centers

Who is eligible in the remaining vaccine phases in the county?
Here are the remaining vaccine phases and eligibility in each priority group. Phases 1B and 1C are the only groups currently broken down into priority tiers.

Phase 1B

Tier 1:
● Adults ages 75 and older (roughly 73,000 residents can now pre-register for an appointment here.)

Tier 2: (includes essential workers who cannot work from home or control social distancing)
● Public transit workers (including transport for elderly residents or persons with disabilities)
● Education sector (teachers and support employees)
● Child care workers
● Food and agricultural workers
● Postal service workers
● Grocery store workers
● People experiencing homelessness
● People in detainee centers

Tier 3:
● Manufacturing workers who cannot work from home and are unable to control social distancing

Phase 1C

Tier 1:

● Adults ages 65 to 74 (about 91,000 residents)

Tier 2: (adults ages 16 to 64 years old with high-risk medical conditions that include)
● Cancer
● Chronic kidney disease
● Chronic Obstructive Pulmonary Disease
● Heart conditions
● Immunocompromised state
● Obesity and severe obesity
● Pregnancy
● Sickle Cell Disease
● Smoking
● Type 2 Diabetes and Type 1 Diabetes
● Asthma (moderate to severe)
● Cerebrovascular disease
● Cystic fibrosis
● Hypertension or high blood pressure
● Immunocompromised conditions (from blood or bone marrow transplant, immune deficiencies, HIV, prolonged use of corticosteroids or other immunosuppressive medication)
● Dementia, ALS and other neurologic issues
● Liver disease
● Pulmonary disease
● Thalassemia

Tier 3:
(essential workers not in previous phases including)
● Transportation and logistics
● Water and wastewater
● Food service
● Shelter and housing (construction, etc.)
● Finance (banks, etc.)
● IT and communications
● Energy
● Legal (state’s attorneys, public defenders, judiciary)
● Media
● Public safety (engineers, etc.)
● Public health workers (non-COVID response)
● Social and human services (aging, human services, etc.) — field/in-home services
● Continuity of government (elected officials)

Phase 2 will include people in critical infrastructure roles, which have not been announced yet.

Phase 3 will open vaccines to the general population.

The state is in Phase 1B. Why isn’t the county?
Similar to reopenings and restrictions on businesses that were specific to each county, the statewide vaccine rollout will not be the same from each jurisdiction to the next.

As of Tuesday morning, the county had administered 95% of the 19,800 vaccine doses it has received — the second highest percentage of the jurisdictions in the state, behind Baltimore County.

But Montgomery County has only vaccinated about 3% of its population of roughly 1.05 million people, landing the county in 21st out of 24 jurisdictions for percentage of population vaccinated.

Smaller counties will have higher percentages because they have fewer residents and received more vaccine doses than were needed for Phase 1A, according to county health officials.

Somerset County, with a population of nearly 26,500, sits at the top, having vaccinated 22% of its residents, including vaccines from hospital systems and the federal pharmacy partnership.

Montgomery County received its first shipment intended to be second doses this week. But the county’s shipments aren’t expected to be significantly higher for second doses , which means fewer first doses will be available unless the state increases the vaccine distribution to the county.

The state has set aside second doses for shipments for residents who have received a first dose.

Dr. Travis Gayles, Montgomery County’s health officer, said those who received a first dose will be prioritized for receiving a second dose. If those second doses are not used, they will be reverted for use as first doses.

A chart shows county-wide vaccinations across the state as of Monday, including how many have been administered and the percentage of jurisdiction populations that have been vaccinated. Chart from Montgomery County

How do you preregister for a vaccine appointment?
You can preregister for a vaccine if you are in Phases 1A and expect to receive appointment information from the county once availability opens. You can also preregister for a vaccine if you are 75 years old or older.

Will you receive confirmation when you preregister? When will you be contacted about vaccine appointments?
An auto-response feature was planned to be enabled Tuesday night that would provide confirmation of preregistration. A text or email with appointment registration information will be sent to registrants once they are eligible for the vaccine.

The county has had around 50,000 people preregister with the county. A regular update will soon be launched and sent to those who have preregistered.

Who is administering the vaccine?
Every local health department is administering vaccines, including Montgomery County. Hospital systems have been providing the vaccine doses to their staff members.

The federal government has a partnership with CVS and Walgreens pharmacies to administer the vaccines in long-term care facilities, Developmental Disability Administration group homes, assisted living facilities, and residential rehabilitation programs.

The county is handling all other priority groups in Phase 1A, though Gayles told the County Council on Tuesday that county officials and hospital administrators have been meeting about potentially including hospitals to vaccinate other groups, beyond their employees, soon.

In addition, Gov. Larry Hogan announced last week that a pilot program with Walmart and Giant would launch on Jan. 25 to begin administering vaccines in their pharmacies.

The program includes:
● 22 Giant locations statewide
● 3 Martin’s locations in Washington and Allegany counties
● 10 Walmart locations in Western Maryland and the Eastern Shore

The program will follow the state’s current phase eligibility, which includes residents ages 75 and older.

Dr. Earl Stoddard, executive director of the county’s Office of Emergency Management and Homeland Security, told the council on Tuesday that of the 22 Giant locations in the state, four will be in Montgomery County:
● 10400 Old Georgetown Road, Bethesda (301-530-3271)
● 229 Kentlands Blvd., Gaithersburg (301-208-8204)
● 1280 East West Highway, Silver Spring (301-565-0575)
● 15618 Columbia Pike, Burtonsville (301-421-4493)

Each will receive about 50 doses a day and administer around 30 to 40 doses each day. No walk-ins will be accepted. People must be included in the currently eligible phases and have an appointment.

More information about the vaccine appointments at the grocery pharmacies is available by calling the pharmacies at the Giant locations.

Do you have to pay for the COVID-19 vaccine?
According to the county’s website, there is no cost for the vaccine at county-sponsored clinics. Medicare, Medicaid and most private insurance will cover the cost of the vaccine. The county will cover the cost for uninsured individuals.

Why does the county only have about 3% of its population vaccinated?
The county has the capacity to administer 2,500 to 3,500 vaccine doses a day, but officials are not receiving the number they need to reach that capacity.

This capacity is expected to increase when hospital and primary care clinics open for vaccinations to the public, and week end county-run vaccine clinics begin. Officials have said they are actively looking for community partners to be able find enough vaccinators and volunteers to start weekend clinics.

Although Montgomery County has the second highest number of vaccinations administered in the state, it also has the largest population that needs to be vaccinated.

Officials have called on the state to distribute more vaccines to the county. Montgomery County is moving more slowly through its rollout than it has happened in smaller jurisdictions because Montgomery does not have enough vaccines for the eligible populations.

The state’s weekly distributions of doses to the county range from its first shipment of 100 doses to 8,600 during the week of Jan. 12.

The state receives 72,000 doses a week and distributes the doses to hospital systems and local health departments.

Where is the county administering the vaccines?
Only people who are currently eligible and have an appointment can receive a vaccine at a county-run clinic.

The vaccine clinics are at:
● White Oak Recreation Center
● Upper County Recreation Center
● Germantown Recreation Center
● Public Safety Training Academy
● Quince Orchard High School

Do you have to live in Montgomery County to receive a vaccine in the county? Can you receive the vaccine in a different jurisdiction?
When asked during a town hall meeting Tuesday night if someone who works in the county but lives elsewhere would be eligible for a vaccine in Montgomery, Gayles said Montgomery County residents will be prioritized first. However, people will not be turned away from the county’s clinics if they live elsewhere.

Prince George’s County opened vaccinations to outside residents through the weekend, but did not have a preregistration component to its system at the time.

Some Montgomery County residents were vaccinated in Prince George’s County. Gayles encouraged Montgomery County residents to contact Prince George’s County’s health department to ask if they will be accepted or turned away.

He encouraged residents and workers to refrain from “shopping” around for vaccinations to make sure they are not taking up multiple slots that could be open for other eligible workers.

Is a COVID-19 vaccination mandated for workers?
There are no current mandates that require workers to receive a COVID-19 vaccine, though it’s possible that individual employers might make their own policies.

How do you find more information?

More information can be found through these resources:
● Montgomery County vaccine website: https://www.montgomerycountymd.gov/covid19/vaccine/
● Maryland vaccine website: https://coronavirus.maryland.gov/pages/vaccine
● Centers for Disease Control and Prevention vaccine page: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html

Health care personnel, medical providers and other eligible individuals can preregister for vaccines here.

Residents ages 75 and older in Phase 1B can preregister for the vaccine here.

A phone number will soon be available for preregistration.

Briana Adhikusuma can be reached at briana.adhikusuma@bethesdamagazine.com.