Covid-19: Vaccine rollout – and resistance – in Baltimore, Maryland

The snow is still on the ground on the bright spring morning as cars begin to trickle into the car park at the M&T Bank Stadium in Baltimore.

The 70,000-plus seater stadium in the heart of Maryland’s largest city, has long been part of the fabric of Baltimore. As the home of the Baltimore Ravens NFL team, its towering shape is a recognisable feature on the city skyline. But like many sporting venues it has closed its doors for much of the pandemic.

Last week the stadium opened with a new mission as it became the state’s third mass vaccination site.

Vicki and David Embrey are among the first to arrive as the stadium opens its doors at 11am. "I guess we got lucky," says Vicki who explains they had phoned the Maryland vaccination site a couple of times a day, before securing one of the first appointments.

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“As a retired teacher, I’ve been more concerned about my teacher colleagues who have to go back to the classroom, so we weren’t frantic about getting the vaccine, but we’re both over 65 and so in the priority group.” She says that while the past year has been tough, it has been more difficult for others. “The worst thing has not been seeing the grandkids,” pipes in David.

Outside the stadium, family members are waiting patiently as some of the first to be vaccinated exit the stadium. Dawn Craig Gunn is greeted with a huge bear hug by her husband. "It felt like winning the lottery," she says, beaming. She received the Pfizer shot and was given an appointment for a second shot in three weeks' time. As an education administrator she was in the eligible group for vaccines as set out in Maryland's vaccination schedule. But like many she had struggled to find a vaccine slot as demand outstripped supply.

Maryland’s vaccine rollout is a microcosm of what is happening across the United States as the country’s vaccination programme steps up a gear.

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Over a year since the pandemic hit the US, America is beginning to see light at the end of the tunnel. It follows a devastating year, which saw the US lead the world in terms of coronavirus cases. As of March 1st, 2021, America had reported 28 million confirmed cases of the virus – almost a quarter of recorded global infections.

America’s coronavirus story began on January 19th, 2020, when a 35-year-old man presented at a clinic in Washington State with flu-like symptoms. He had recently travelled from Wuhan, China. It was America’s first-known Covid-19 case. The initial cluster on the west coast quickly spread as pockets of outbreaks began to be reported throughout the country.

In Boston, a conference held by biotech company Biogen on February 26th and 27th gave rise to a cluster that led the Massachusetts governor to declare a state of emergency. A study published in the journal Science in December estimated that the Biogen gathering was ultimately linked to 300,000 infections.

In New Orleans, the annual Mardi Gras festival went ahead in late February. The crowds of sweaty revellers that descended on the city proved to be a conducive breeding ground for contamination.

Louisiana quickly found itself with one of the fastest-growing coronavirus clusters in the world, with minority groups and poorer residents most affected, an early sign of things to come in the US.

Within two months of the first case being reported, the pandemic was raging. Nowhere more than in New York. Almost 2 million residents had contracted the disease by early April, with New York state reporting 1,000 deaths per day at the peak of the outbreak.

The US’s rapidly escalating coronavirus crisis unfolded against a toxic political background.

President Donald Trump, eager to get on the campaign trail in an election year, brought a mix of defiant denialism and scientific scepticism to a public-health crisis that was rapidly getting out of hand. As health experts such as Dr Anthony Fauci became the public faces of the health crisis, the former president pushed himself to the forefront of the White House response to the pandemic, regularly appearing at daily televised coronavirus task force briefings.

His yearning for public attention backfired, as he meandered his way through briefings, ill-informed and underprepared, suggesting at one point to an incredulous public that injecting bleach could be a cure for the disease and promoting untested treatments such as hydroxychloroquine.

Meanwhile, lack of testing and proper personal protective equipment was exacerbating the problem in communities as healthcare systems struggled to cope.

Like almost every aspect of life under the Trump presidency, the US response to the pandemic became politicised at an early point. Mark-wearing became a partisan issue, as Trump and other Republicans eschewed the use of face coverings.

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More than a year on, America is starting to turn a corner. The virus is still spreading – the US is reporting more than 65,000 new cases a day on average – but the rate of infections has slowed from the post-Christmas January peaks.

Much of the new optimism is centred on vaccines. The first Covid-19 vaccine was approved for use in the US on December 11th, 2020, when the Pfizer-BioNTech vaccine secured approval from the Food and Drug Administration. Approval was granted to Moderna, which received tax-payer dollars for research and development, a week later.

Though “Operation Warp Speed” – a Trump administration public-private initiative – managed the vaccine procurement and distribution, much of the vaccine rollout fell to individual states.

As with the coronavirus testing system, the lack of a strong centralised federal system led to problems with supply and distribution. By January it was clear that America was struggling, with a patchwork of different systems operating across the country. In Ohio there were reports of oversupply, with the governor claiming that 60 per cent of nursing home workers were refusing to take the shot. In Florida, in contrast, seniors queued overnight in their cars to secure appointments.

On assuming office, Joe Biden prioritised the fight against the virus, announcing plans for a national vaccination plan.

Greater focus on the pandemic by his administration, coupled with an increase in supply from manufacturers, is beginning to show results. Approximately 1.7 million vaccines are being administered a day, while there will be enough doses to vaccinate every American adult by the end of May.

The rapid pace of development is giving grounds for optimism.

This week's decision by the governors of Texas and Mississippi to lift their states' mask mandate in defiance of CDC guidelines is indicative of the challenges ahead

“We’re certainly in a better place than we were a month ago or even a week ago,” says Dr Leana Wen, public health professor at George Washington University. “We are heading in the right direction – increasing the rate of vaccination, increasing supplies of vaccination. But there are still many challenges. Right now the challenge remains supply and distribution of the vaccine.”

Maryland, a state of about 6 million, captures some of the challenges facing states across the country as they implement their vaccination programmes.

Here at the opening day of the M&T stadium vaccination site in Baltimore, the vaccination system is up and running. Rows of gleaming pods are lined up along the area that usually serves as the VIP lounge. The state’s National Guard – some of whom were deployed to Washington in January as back-up in the wake of the Capitol Hill riots – are on hand to help.

Governor Larry Hogan is touring the facility which he hopes will eventually administer 10,000 jabs a day. But this depends on supply – a responsibility of the federal government in Washington which has been managing vaccine allocations to each state. Hogan, a Republican governor who is a critic of Trump and ordered his own coronavirus tests from South Korea last summer when he felt the federal government was not doing enough, says he is pleased with the Biden administration’s coronavirus strategy.

“We’re working very closely and in partnership with the Biden team,” he says, noting a weekly conference call that takes place between state governors like himself and Jeff Zients, the White House coronavirus co-ordinator.

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But like most states, the number of doses the federal government supplies is simply not enough to meet demand.

Virtually all residents arriving to get vaccinated at the M&T stadium complain of difficulties accessing websites or getting through to healthcare providers.

Maryland has implemented a tier system for distribution based loosely on recommendations from America’s main health agency, the CDC (Centre for Disease Control and Prevention): Phase 1A focused on health workers, nursing home residents and first responders like firefighters; Phase 1B extended to over-75s, teachers, and residents of long-term facilities, while Phase 1C is over-65s and more essential workers like postal and manufacturing workers. All three phases have now opened up.

It means millions of people are now technically eligible to receive their jab but there are not enough doses to go around.

The approval of the Johnson & Johnson vaccine will boost supply – Maryland is expecting almost 50,000 doses of the one-shot vaccine this week alone – and the administration has been gradually increasing supply to each state week on week since mid-February.

Another issue facing the vaccine rollout is inequity of distribution.

There are already signs that communities of colour are less likely to receive the vaccine – the very communities that have been disproportionately affected by the pandemic. One of the reasons is barrier to access . Most people need fast, reliable internet access to secure an appointment slot, while many of the sites can only be reached by car.

Here in Baltimore – a black-majority city – those arriving for their jabs are overwhelmingly white. State data shows that white residents have received four times as many doses as black residents in Maryland.

The state has introduced measures to try to close the vaccination gap, using mobile vaccination clinics to bring vaccines directly to people, including at black churches.

Vaccine scepticism is also an issue – a problem recognised by President Biden. Noting America’s shameful history of experimenting with medicine on black patients in the past, Biden has repeatedly appealed to communities to take a vaccine when they are offered it.

On a broader level, infectious disease experts in the US say the aim is to vaccinate enough people and reach herd immunity in time to combat a new wave of infections or variants – a race between vaccinations and variants.

But this week’s decision by the governors of Texas and Mississippi to lift their states’ mask mandate in defiance of CDC guidelines is indicative of the challenges ahead.

Noting the emergence of new variants, CDC director Rochelle Walensky warned Americans this week not to let their guard down. “We stand to completely lose the hard-earned ground we have gained . . . now is not the time to relax the critical safeguards that we know can stop the spread of Covid-19 in our communities.”

Whether enough Americans take heed may be a crucial factor in how the pandemic evolves in the coming weeks.