Vaccination efforts across rural Maine to deal with the COVID-19 pandemic are going as well as could be expected, according to emergency management officials in eight northern counties, but plans for future phases remain fuzzy. And at least one official is frustrated because emergency management agencies, he feels, have been sidelined in the vaccination rollout. 

Nearly all eight directors of county emergency management agencies (EMA) told The Maine Monitor their primary concern was the limited and uncertain supply of vaccine doses coming into the state. And many said it could be a logistical challenge to coordinate group vaccination events, which could be key in immunizing the general public.

Peter Rogers, director of the Maine Emergency Management Agency (MEMA), said while a lot of unknowns remain about future vaccination phases, the planning process is underway.

Thomas Capraro, the Piscataquis County EMA director, said plans are changing daily as agencies search for locations to hold large vaccination events.

“I think they haven’t really decided on most rural areas,” Capraro said earlier this month. “I haven’t heard anything permanent or solid. But we meet on a Zoom meeting with (Northern Light Mayo Hospital) every week. As things change, this has been changing daily as we try to find the right mix.”

The Maine Center for Disease Control and Prevention leads the state’s pandemic response with emergency management in a supporting role. County EMAs — which typically coordinate preparation, response and recovery during natural disasters — are not in charge of the vaccinations but they have served as liaisons between hospitals, public safety and state agencies.

Many of the county EMAs praised the communication from state agencies and one said he’s in nearly constant communication with his district CDC liaison.

However, the Waldo County EMA director, Dale Rowley, said he was frustrated that emergency management agencies haven’t played a large role, with the CDC sending vaccination doses directly to hospitals and pharmacies.

“This is my own opinion: There’s still a debate from Washington D.C. to Augusta of whether public health people are in charge or emergency management people are in charge,” Rowley said. “In most cases, emergency management has lost that debate. It all comes down to money. The money is going through the CDC.”

The Maine CDC, which is under the Department of Health and Human Services, determines each week where vaccine doses are sent throughout the state. In the first phase, the bulk went to hospitals to vaccinate frontline workers. A federal pharmacy program has coordinated vaccinations at long-term care facilities and ambulance services have been in charge of first responders.

As of Jan. 22, 98,371 Mainers had received their first dose. Of those, 19,876 had received their second shot.

Rowley said he has an “all-hazard emergency plan” that includes sections on specific disaster scenarios, including a disease outbreak. Though the CDC has its own vaccination plan, the response has felt “disjointed,” Rowley said, with hospitals, ambulances and pharmacies vaccinating different groups of people.

“If we activated our emergency operations center, we’d have representatives from each area sit down and build a plan to do it in Waldo County,” he said. “The governor would come up with the priorities and we would implement them.”

Dr. Nirav Shah, the Maine CDC director, on Jan. 19 said he understood the concern, which is why he held a meeting this month with all 16 county EMA directors to lay out operation plans. And he said he keeps in daily contact with Rogers, the MEMA director.

If it feels like multiple groups are doing the same thing, Shah said, that’s because it’s a complicated process to quickly ramp up vaccination efforts and he doesn’t want anything to fall through the cracks.

Jeanne Lambrew, commissioner of the Maine Department of Health and Human Services, added that the federal government set up the vaccination effort to be funded through health insurance, which is why the state’s healthcare system has played such a prominent role.

“We have absolutely benefited as a state from the partnership that we have had with county-level emergency managers across the state, top to bottom, east to west,” Shah said. “They understand their communities and counties exceptionally well, so when we make decisions about where and when we might start vaccinating folks, we don’t intend to do so without making sure that that works for (the EMAs). We’ve done that all along, we’ll continue to do that.”

The seven other EMA directors in northern parts of the state said there’s been good communication from the CDC and praised the cooperation among local organizations in planning for the vaccination rollout. 

Rogers said he “periodically” hears complaints similar to Rowley’s, which he says comes from the desire to be helpful.

“It’s tough because you always want to do more,” he said. “You always want to lean forward and help out, and sometimes there’s just not enough answers to really be able to do that effectively. And that’s where I think sometimes the frustration goes.”

Rogers said he doesn’t feel like his agency has been sidelined because it’s been active since March.

“The bottom line is, it’s a public health crisis,” he said. “That being said, because of the magnitude of this, we’ve really been side by side with those guys from the very beginning.”

‘We’re planners. We work in emergency management.’

Maine is in Phase 1A of its vaccination effort, which includes healthcare workers, emergency responders, COVID-19 response personnel and residents of nursing homes. The state expects to move into Phase 1B next month and begin vaccinating seniors over 70, frontline workers and people with high-risk medical conditions.

Many county EMA directors said there haven’t been any major issues in the initial vaccination efforts in their areas and most said their counties were essentially done with Phase 1A.

Bradley Nuding, the Penobscot County EMA director, said he couldn’t think of “anything as far as Phase 1A that could have gone better,” but added that could be because it involved a small portion of the population.

“It worked well because there were not a lot of people and there was sufficient vaccine to do it,” he said. “Speaking broadly, as we … get into larger groups, it’s going to take a lot more coordination and planning.”

As the state moves toward vaccinating the general public, coordinators face unique logistical challenges. Large vaccination clinics, if not organized well, could risk becoming superspreader events because people have to be monitored for 15 minutes after the shot to make sure they don’t have an allergic reaction. And then officials have to plan for them to come back on the same day for their second shot.

Around the state, officials said they are working with other community partners to find locations for larger vaccination events and solutions for reaching older people or those without transportation.

In Hancock County, the EMA director, Andrew Sankey, said he’s working with local organizations to find space for a public vaccination clinic in vacant buildings, school facilities or places like the American Legion Post.

In Piscataquis County, Capraro said he expects neighbors will help drive each other to clinics.

“A lot of these towns we have here, they really take care of the elderly,” Capraro said. “Usually every town knows everybody who might need assistance. Mainers are really good at looking out for each other. You’re going to get that everywhere. Up here there’s a lot more neighbor-to-neighbor stuff that goes on.”

The small and changing amount of vaccine doses coming into Maine from the federal government has frustrated state CDC and county officials. This month it was revealed that a reserve of vaccines that the federal government said it was saving for second doses did not exist. 

In Oxford County, the EMA director, Allyson Hill, said she wished there was a national framework for distribution so states could coordinate more efficiently.

“We’re planners. We work in emergency management. We have the information and then we figure on from there. We’ve been doing pretty well for almost a year now. We’ve gotten quite used to that and things are going quite well, but it would be nice to create a plan from some federal knowledge so the state could make it clear to everybody when they can start to receive vaccines,” she said.

Shah frequently has voiced frustration with the number of vaccine doses Maine has received from the federal government. For the week of Jan. 25, Maine expects to receive 17,575 doses of vaccine — 975 fewer than the prior week. This allotment will bring Maine’s total to 135,150 doses.

In rural areas, geography and weather present an even greater challenge, said the Aroostook County EMA director, Darren Woods. He expects to have multiple sites throughout the sprawling county to reach everyone. But, he added, these are challenges Aroostook County deals with all the time, not just for the pandemic.

“We just have to try to be patient and work through the process,” Woods said. “We want to do this the right way. We can’t rush through something like that. We can be quick and efficient but we cannot be rushed through the process.”