GOVERNOR HOGAN: Good afternoon. Joining me today from the Maryland Department of Health are Deputy Secretary for Public Health Services, Dr. Jinlene Chan and Assistant Secretary Bryan Mroz. As we battle COVID, one of our highest priorities continues to be securing additional relief for families and small businesses. Yesterday a group of governors joined with me and again strongly urging leaders of congress to immediately act on a COVID‑19 relief package. Many CARES act programs including the paycheck protection program have already run out and many more critical programs are set to expire by the end of this month. So many of our families and small businesses are hanging on by a thread. And it would be unconscionable for congress to cut their lifeline right now. We recognize that there are legitimate differences of opinion on what the amount of relief should be and what the package should contain. But these differences pale in comparison to the cost of doing nothing. We don’t have time for any more excuses, delays or any more partisan political gamesmanship. Congress simply must come together to take action now on a bipartisan compromise relief bill.
Back in February, I said that I was confident that our state would be a national leader in developing treatments and perhaps even a vaccine for COVID‑19. Researchers at the University of Maryland Medical Center were the first in the United States to begin testing Pfizer’s vaccine. Montgomery County is about to begin phase three trials on their vaccines. Emergent BioSolutions headquartered here and has six sites in Maryland with 1500 employees is manufacturing vaccines for both AstraZeneca and Johnson & Johnson. Nearly 40 Maryland companies have been working on developing and manufacturing COVID‑19 vaccines and innovative therapeutics. Our team at the Maryland Department of Health has worked hard over the past eight months preparing plans to procure, distribute and administer COVID‑19 vaccines when they became available. Our vaccination plan was submitted to the CDC back in October and in November, we committed an additional investment of $1 million for the acquisition of a strategic stockpile of syringes and other necessary supplies for the vaccine. We’ve had regular meetings with the White House coronavirus task force and the leaders of Operation Warp Speed and we’ve been working closely with our hospital systems and our local jurisdictions in order to be prepared for the initial distributions of the vaccine. To be effective, that’s vaccines need to reach a vast majority of our population. And to do so in a relatively short period of time. This is, by far, the most massive undertaking of this pandemic. In order to further prepare our state and to ensure that we’re ready to distribute the vaccine widely, today the Maryland Department of Health has issued an order which expands the scope of practice for licensed providers so that any health care professional including all doctors, nurses, paramedics and pharmacists will be able to administer COVID‑19 vaccines with appropriate training and under proper supervision.
Today’s order also provides that health care providers who are already capable of performing the vaccinations may prepare and administer COVID‑19 vaccines at state‑designated vaccination sites. To help demonstrate confidence in the safety of the vaccine, I want to make it clear that governor Rutherford and I will both take the vaccine in public as soon as it becomes available to us. And we will be leading an aggressive statewide public health campaign urging all Marylanders to vaccinate. While the delivery of vaccines is very welcome news, I would caution Marylanders to remember that our initial allocation would only be 155,000 doses of the vaccine. With the possibility of perhaps up to 300,000 by year’s end.
It is often said that it is always darkest before dawn. Right now, we do remain in a better position than many other states. The ninth best rate and we’re the fourth best mask‑wearing state in the nation with 96.7 percent compliance. However, in spite of all of that success, it is clear that our worst days of this pandemic are still yet to come in the weeks and months ahead. On Friday, we hit a daily record for confirmed cases. We’ve now had 35 straight days with more than 1,000 cases. Maryland’s 7‑day statewide positivity rate is 7.61 percent and our cases per 100,000 is now at 44.8. The death toll continues to climb. The United States is now losing one person to COVID‑19 every 30 seconds or less. The virus has taken the lives of over 283,000 Americans including 4,755 Marylanders. And today, for the first time, since May 22nd, we’ve reported more than 50 deaths in a single day. 1,653 COVID patients are hospitalized today in Maryland which is the highest level since May 9th. 396 Marylanders are currently in intensive care units which is the highest level since June 7th. 85 percent of our staff are occupied and 87 percent of our ICU beds are occupied. 142 surge beds are currently in use at the Baltimore Convention Center field hospital that reopened Laurel Hospital and the expanded Washington hospital, all of which we added this spring. We have now activated our critical care coordination center that allows us to ship patients between hospitals. It has already resulted in the successful placement of 38 patients among 18 different hospitals. We have received an enthusiastic response to our call for medical staffing search. In the first week since I announced it, 4,268 prospects have signed up to work at our hospitals, nursing homes, testing sites and vaccination clinics. Anyone interested in these positions can go to mednow.com. An additional 576 volunteers joined from our Maryland responds med reserve corps which has a total of 15,980 people signed up. More than 1.2 million Marylanders have subscribed to our MD COVID alert contact tracing app which according to Google, is our state’s number one rate in the nation. We are encouraging everyone to opt in to help allow us to stop the spread and protect our fellow Marylanders. Lastly, we’re monitoring active cases at 190 nursing homes and at 132 assisted living facilities. Nursing homes cases remain higher than during the initial spring outbreak.
The Calvary is coming. A vaccine is on the way. But it is absolutely critical that we continue to fight this virus with everything we’ve got and we all need to keep doing the things that we know will help keep us safe. To provide an overview of our plan for the initial roll‑out of the vaccine in Maryland, I’m going to turn it over to Deputy Secretary Chan and Assistant Secretary Mroz.
JINLENE CHAN: Thank you, governor. We are pleased to be here with you this afternoon to give more details about our plans to roll out COVID‑19 vaccinations in Maryland. Since early in the pandemic, we knew that having a safe and effective vaccine would be an important tool to help us save lives. Just as we in Maryland have been working around the clock to respond to the COVID‑19 pandemic through testing, contact tracing, expanding our hospital surge capacity and a multitude of other response efforts, we know that scientist and researchers around the world, here in the United States and even here in Maryland have been working also around the clock to develop and test a vaccine through a phase one, two and three clinical trials.
Now the early data from the first two vaccines being considered in the United States have shown a high level of effectiveness in preventing disease from COVID‑19 and most people involved in the clinical trials have reported minimal side effects. COVID‑19 vaccination implementation will continue to evolve in concert with our federal partners and vaccine manufacturers and we’ll share more information as we have it. What we will discuss today is the information that we have to date based on the planning that we have been doing over many months and I want to turn it over to Bryan Mroz to speak to some of our planning work.
BRYAN MROZ: Thank you, Dr. Chan. Thank you, governor, for giving me the opportunity to discuss this important initiative. Our planning in preparation in Maryland, began ‑‑ started when the pandemic began as early as April, Maryland Department of Health began developing a vaccination plan. By mid‑October, Maryland had submitted our COVID vaccination plan to the CDC. In October, we also started to secure supplies that we knew would be needed for the mass vaccination efforts.
In November, we began convening our advisory groups, technical, minority health, vulnerable population and other outreach groups. Also in November, Governor Hogan announced a $10 million in additional funding to secure ancillary supplies such as syringes, personal protective equipment and freezers. These are a few of the ways in which Maryland has been preparing for the vaccine. Preparations were also occurring on the national level. Multiple pharmaceutical companies began developing vaccines months ago. Clinical trials occur in three phases and in the last phase, tens of thousands of volunteers. Once it demonstrated a high level of efficacy and safety, the pharmaceutical companies can then apply for an emergency use authorization. So far only two manufacturers applied for this emergency use authorization. Currently these two companies are manufacturing millions of doses in anticipation of federal approval. The federal department has prioritized these for delivery across the United States. Once approved, these allocations will be shipped directly to the providers such as hospitals, pharmacies and clinics.
In addition to distributing the vaccine, the federal government is shipping the ancillary supplies associated with administration. This entire development distribution process is monitored and staffed by the FDA, the CDC to maximize security. With security and efficacy in mind, I wanted to bring Dr. Chan back up to discuss the two candidates that have applied for authorization.
JINLENE CHAN: Thank you, Bryan. So as you’ve heard, there are two candidates. The first one is from Pfizer. Some of the early data that they released in early November from their phase three clinical trials suggest that there is 94 percent to 95 percent efficacy in the risk among people who got the vaccine compared to people who did not get the vaccine or who got the placebo. This also was highly effective even among individuals who were older. And the results were after the second dose. Both vaccines require two doses for maximum efficacy. It is important to note that in some of the early information provided by Pfizer that even in preventing severe disease, it is closer to 100 percent. Again, on‑going information and tracking of individuals who participated in the trial will continue to identify potential side effects as well as clinical outcomes. Pfizer submitted on November 20th their application to FDA for an EOA approval and later this week on December 10th, the FDA’s advisory committee will be considering the data and make a recommendation to the FDA on whether to approve or not. In the time frame since Pfizer submitted their application, the FDA has been carefully considering the data that has been submitted and so our FDA’s process in considering any vaccine application is that they independently analyzed the data that’s submitted to them by the vaccine manufacturer coming out of all of the clinical trials so that they could make an independent determination not only about efficacy but also about side effects and other impacts within the volunteers who participated in the trial. If approved, which we anticipate it will be, we believe that the initial doses of the Pfizer vaccine will become available for Maryland as early as the week of December 14th or next week.
Now Moderna is the second vaccine that has submitted their application to the FDA for EOA approval. Early data that Moderna has released shows it also has similar efficacies to the Pfizer vaccine with about 94 percent efficacy. They applied on November 30th and the FDA’s advisory committee has already scheduled a meeting to consider their vaccine data on December 17th which the anticipation that, if approved, then the week after on the week of December 22nd, that Maryland will be able to receive the Moderna vaccine for use.
So as Maryland has considered how to best allocate the initial vaccine doses, we’re taking into account a number of key priority considerations. First, our federal recommendations with our federal partners, CDC just last week, their advisory committee on immunization practices, on Tuesday released their initial recommendations to the priority grouping for stage 1A to include health care workers and the residents of long‑term care facilities. Long‑term care facilities would include nursing homes as well as assisted living. We have also considered the groups at highest risk for complications or deaths from COVID‑19 and as many people know and the governor has indicated, nearly half of our deaths have occurred in individuals in nursing homes and we currently have 190 active outbreaks in nursing homes and over 130 in assisted living. So these are among the highest risk groups in Maryland. It is also critical that we preserve our health care capacity and that has been in consideration for the entire course of the pandemic and more recently we issued a number of orders and guidance with the intent of maximizing our ability to deploy our critical health care infrastructure to be able to care not only for individuals with COVID‑19 but people who come to seek health care or other conditions whether in the hospital or in outpatient status. So as seen in this graphic, our approach in Maryland will be to include in that phase 1A all health care workers, long‑term care facility staff and residents as well as first responders. That will include nursing homes as well as assisted living where we have had, as we’ve mentioned, a significant impact. As we receive more vaccine in the weeks and months to come, we will continue to expand the groups who are able to access the vaccines including high‑risk such as those with chronic pulmonary disease, chronic kidney disease or heart conditions and also adults in other congregate settings. We’ll move quickly into phase 2 which will include people who work in other critical essential infrastructure settings and be able to open the vaccinations up for them.
And ultimately, our goal in Maryland is to make sure that COVID‑19 vaccine is available for every Marylander who wishes to have it. As we approach phase 1, we will be focusing primarily on the vaccination of the high‑risk population. Again, in alignment with the federal guidance. We anticipate that after the FDA approves each of the vaccines, that the CDC’s advisory committee on immunization practices will reconvene to provide additional guidance and information specific to the Pfizer and Moderna vaccines based on the detailed data analysis they will have done. The CDC will provide us with information as we go forward on the number of doses as that will have available week after week. While we expect that limited availability initially, we do believe that we will continue to get doses not just in the first week but in the second week and in the weeks and months to come. Phase 2 will begin when targets for phase 1 have been met which will include factors including whether most of the target population have been actually offered or made an opportunity to have a vaccine or to be vaccinated. Then expansion into phase two will include those workers, as I mentioned, who work in the critical infrastructure settings such as in education, transit, utility workers and others.
Our vaccination efforts will continue until all Marylanders are able to access the vaccine. As noted, Maryland will align with federal recommendations as much as possible. So we have now received word from the CDC that the state will receive approximately 155,000 initial doses from the Pfizer and Moderna. Pfizer, we anticipate we will be getting 50,000 doses and because Pfizer will likely be the first vaccine to be approved, those will be able to come into the state and be used first. Moderna has provided 104,000 for the state of Maryland in the first allocation. And that will come to the state once that is approved. Now based on the considerations we have discussed, the state has decided to divide our initial allocations among the groups that have the most ‑‑ the highest risk that we have seen in the state to start with hospital‑based health care workers and nursing home staff and residents. These are only the first doses that we will receive and more will continue to come week after week and provide ‑‑ we’ll be able to provide those to hospitals and to nursing homes. Of note, with the long‑term care facilities including nursing homes and assisted living, the state of Maryland has signed up for the CDC pharmacy program which is a partnership that the federal government has contracted with CVS and Walgreens to be able to administer vaccines in those settings. We’re engaging with both of them to make sure our efforts are coordinated. And in fact, all nursing homes and assisted living have been signed up on their behalf. They have the option to opt out. That we would certainly encourage all of them to participate in the program so that there is a workforce available to actually administer vaccines in their settings again to the highest risk individuals there.
As the vaccine becomes more available, we’ll follow our allocation and distribution plans and begin to distribute to local health departments who will be able to make the vaccine available for first responders and others going forward. I would now like to ask Bryan to come back up and discuss some of the logistics of vaccine ordering and distribution.
BRYAN MROZ: Thank you, Dr. Chan. In terms of ordering vaccines, we’ll be using ImmuNet. It is the cornerstone of Maryland’s immunization information system. Providers will place orders in ImmuNet. It will go to the federal government and the federal government will then distribute those vaccines directly to the provider. ImmuNet is also used to store vaccine records. ImmuNet is HIPAA compliant and is used to safely and securely manage personal health information associated with vaccines and immunization. ImmuNet has been used in Maryland for over 15 years and is currently used to store every record of vaccines administered in Maryland. We’ll be using it for COVID but we also use it for non-COVID. We’ve enhanced the capabilities and capacity of ImmuNet to handle the additional information expected with the COVID pandemic. We talked about storing the records but let’s say someone wants their own record. Can they get it? The answer is yes. We have established a consumer access portal. An individual who has been administered a vaccine, even currently, can go to MD.MyIR.net and download their own vaccination records.
So we’ve talked about storing records but let’s talk about storing the vaccine. I know there are a lot of questions about this. As many of you know, the vaccines will come to us frozen. They will come shipped frozen. Pfizer vaccine is minus 80 degrees Celsius. Moderna will be shipped at minus 20 degrees Celsius. Most providers of vaccines already have the ability to store vaccines at minus 20 degrees so that leads to minus 80 degrees Celsius. To make sure they remain frozen, Pfizer has created insulated containers that you can see in this picture. It looks like a shipping container. There is insulation and dry ice with the vaccine and the dry ice on top. It is about the size of a suitcase and weighs about 70 pounds. It is GPS track and the temperature is constantly monitored. Dry ice can be reloaded to assure that it is the correct temperature. If we wish to store it in the shipping containers, they can last for weeks as long as we continue to reload the dry ice. If we do not want to use these containers to store them in, they would have to be stored in freezers specifically designed for ultra-low cold temperatures. As you can see from the picture, this is an example of what one of the refrigerators looks like. The state has secured several of these freezers to make sure we can store in addition to that, we have contracted with institutions and organizations that have ultra-low cold storage capability and we have established contracts with multiple vendors with dry ice supplies. We feel confident we can handle the storing of the vaccine either in the shipping containers or in ultra-low cold storage.
I would like to move on to another concern that has been mentioned which is vaccine confidence. The governor spoke about that. He’s willing to be one of the first to step up to take it. While we recognize there is vaccine hesitancy out there and we’re committed to hearing these concerns, the governor is committed to on‑going statewide communication that will be led by Governor Hogan. We will work on local outreach and collaborative with trusted community leaders and voices to understand community hesitancy. We will communicate what we know and what we don’t know. We will share safety information such as side effects in a language and style that is easily understandable. We feel that the best way to build confidence is open communication. And this comes with a caution. We are already aware that there are rumors, misinformation circulating on social media. We asked everyone to get their information from trusted sources that are based on facts and science. We know there are questions out there and I would like to invite Dr. Chan back up to address the common questions that have already been raised.
JINLENE CHAN: Thank you, again, Bryan, for talking through the logistic aspects of our vaccination plans. We know that there are many questions out there and that you have questions as well. So I want to address some of them that I know are front and center for health care workers and for our community. And so one question is about the safety of the vaccine. And what we know from the vaccine trials is Pfizer enrolled 40,000 people which is quite a large vaccination trial and Moderna enrolled about 30,000 individuals with some significant effort to ensure diversity and the people that were involved in terms of age, race and ethnicity. As I mentioned earlier, it appears that among all of those groups and I believe Pfizer just released ‑‑ I’m sorry, FDA just released Pfizer’s data earlier today but we believe that the efficacy is consistent across different age groups as well as race and ethnic. However, side effects are important to understand and so these vaccines, among the people who receive the vaccine, they did experience some mild side effects but most people did not. Some of the side effects that people did experience were primarily in the first one to two days after receiving the vaccination and as one might expect, pain at the site of the injection, mild fever, headache, muscle aches and joint aches as well. And this shows actually that the vaccine is working. The body’s immune system was responding to the vaccine to be able to produce the protective antibodies that would protect the individual. Another is that there are groups that are monitoring the results at every step of the way. For both Pfizer and Moderna, their data monitoring communities did not flag any safety concerns throughout the course of the vaccine trials to date and they will continue to monitor the follow‑up of the individuals enrolled in the vaccine trials for at least another couple of years. So that’s important to understand. We know that the early information about side effects, about 10 percent to 15 percent of people in the early reports may experience mild to moderate impact, back to the pain at the site of injection and some headaches and fever and muscle or joint aches.
Another question that people have asked is is the vaccine safe for children? That’s a really good question. Right now, the vaccine trials have only been done in adults. So it is anticipated that any EOA approval or recommendations from the CDC will only be for adults at this time. However, the clinical trials have already started to enroll children as young as 12 and will be enrolling younger children. We anticipate that the results from future trials will provide us more insight into the efficacy and safety in children. Another question is will I need to be vaccinated every year? At this point, we do not know how long the immunity will last. There are some who suggest there may be a need to get a vaccine or a booster similar to a flu vaccine once a year. At this time, we do not know whether or not that will be necessary. Again, as we follow the individual through the trial, we’ll be able to have more information and provide those answers to you. Another question, do I need to keep wearing a mask after I get vaccinated or keep social distancing? That’s front and center on everybody’s mind. The vaccine will protect the person who is getting vaccinated from getting the disease but it is still important and we believe it will still be important for everyone to wear a mask and practice safe social distancing and hand washing to prevent potential transfer or spread of the disease to people who are unvaccinated.
And then when can I pre‑register for the vaccine? I know many Marylanders are ready to get the vaccine and want to learn more information about the vaccine and in the coming weeks, we will be rolling out more information as well as a mechanism for Marylanders to actually pre‑register and sign up for an appointment. Again, as we move into phases two and three, we’ll be able to have that available for all. I know that there are many other questions and we commit to providing Maryland with updates. So thank you and I will turn it back to you, Governor.
GOVERNOR HOGAN: Thank you, both. We’ll open it up to questions. The experts will handle the hard ones and I’ll answer the easy ones.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: I totally understand the fact that there are a lot of people out there that don’t trust it. I’m not sure who said it about we want to engage in a micro, local level. Community leaders and people that will help convince others that it is safe. We’re going to be doing it ourselves but we’re going to engage people in every community to help with that convincing.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: That’s a great question. The answer is the 155,000 doses are the initial allocation and the federal government is holding back the second batch of those 155,000. It is not half of the 50,000 and we have to hold them. We’ll get the first batch and we’ll get the second batch later and the additional capacity to do additional people.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: Yes. One shot of the two shots needed. The second shot which we’ll get within the time frame that they need to get the second shot.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: We’ve had assurances from everybody at the federal level and Operation Warp Speed and so far they’re ahead of schedule so I’m hoping that will continue.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: We have an incredible process here in the country. I can assure you that all of the people who know more than I do have done quite a bit of studying and they believe it is safe. I have had conversations with all of the leaders as I mentioned, the coronavirus task force and Dr. Fauci and Dr. Birx and Dr. Redfield from the CDC and everybody involved believes it is safe and very effective, more effective than any other vaccine even in history and that’s going to help us save a lot of lives so I don’t have any hesitation at all.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: What we think is we’re going to get 300,000 by the end of the month which is pretty fast. Coming out every week if things go coordinate according to plan. We have about that many frontline workers. It will be limited to the 1A group as they were describing the pyramid. The production will ramp up for both Moderna and Pfizer but we also have the other numerous other companies that are getting close to having their vaccine available. So the hope is that we’ll have similar success with some of the other companies including the ones I mentioned here in Maryland with AstraZeneca and Johnson & Johnson working together with Montgomery County and others so that we’ll have a growing supply coming from different places and different manufacturers.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: Maybe that’s something Dr. Chan wants to address but we don’t have an intention of requiring the vaccines but we’ll do everything we can to encourage. I don’t know if you want to talk about kids and schools.
JINLENE CHAN: Thank you for that question. As I mentioned in my remarks, the clinical trials right now are just getting underway for children so we have very little information about what the efficacy and side effects for children will be. When that time ‑‑ and also I guess the other important component is that the vaccine will be approved under an emergency use authorization which has the same rigorous look at all of the data as through a normal process but because we’re in a state of emergency and because we have individuals being hospitalized and dying from COVID‑19, this is a very expedited review process. So I think down the road, there may be considerations for that but it would be premature right now to make that a mandatory requirement.
SPEAKER: (Off Microphone).
JINLENE CHAN: We communicate on a regular basis. We call each other every single week to talk about how the pandemic is evolving and the impact on schools and school children. The guidance we issued back in August, we are looking at new information that’s coming out to assess whether or not there may be a need for changes. However, the other question is about how is the guidance. I believe within certain settings, there may be an opportunity to bring children back in small, limited groups and particularly children who have ‑‑ who have had more difficulty with distance learning or those with special needs.
SPEAKER: (Off Microphone).
JINLENE CHAN: I believe, if I remember correctly and I think it is around 800,000 in the 1A population, we believe that is the case. So as we get vaccines, we’ll start with the highest risk so within hospital settings, and then in nursing homes and as we get more vaccines, as we complete the vaccinations of those groups of individuals and we get more vaccines, we’ll be able to expand the number of people and the groups that are able to access the vaccine with assisted living, with other health care providers including in outpatient settings and first responders. So we’re going to move as quickly as we can through each of the priority groups so that we are sure that all health care workers have the opportunity to be vaccinated.
SPEAKER: (Off Microphone).
JINLENE CHAN: Absolutely. There are various considerations in terms of how we begin to allocate vaccines to different groups. Certainly a number of people, it doesn’t make sense to give a Montgomery County or Baltimore County fewer doses than a county out in western Maryland, for example. So those were some of the considerations. Some of it will be dependent also on the logistics involved. As you heard, from Bryan, the Pfizer vaccine requires the ultra-cold storage and very, very careful handling so that will also be a consideration about who can manage it and who can handle the types of vaccines that will be available. Again, these are only the first two we know of and we have a lot more information about these than the others that are currently in phase three or in earlier phases of trials.
SPEAKER: (Off Microphone).
JINLENE CHAN: That’s a great question. In the early phases, we’re directing our vaccine to facilities primarily and also working closely with local health departments who have had years of experience in doing vaccination clinics. Some of them have done mass vaccination clinics for many years so the process is similar in that way. However, as we receive more vaccines, we’ll be opening up in the coming weeks, the registration portal for providers in ImmuNet to be able to register to order and receive COVID‑19 vaccines. So those providers will include pharmacists, primary care providers, urgent cares and others. So ultimately, the goal when we’re able to reach phase three, that we have sufficient vaccines of potentially multiple different kinds that providers can put in an order through ImmuNet and we can pull fill the order, submit that to the CDC and the vaccine would be sent to them. That’s how Marylanders will be able to access that.
SPEAKER: (Off Microphone).
JINLENE CHAN: Correct. Each of the vaccine kits that are coming from the manufacturer and the CDC will actually come with a paper record as well. It is important for people to know and Bryan alluded to this in his remarks that through ImmuNet and through MD.MyIR.net are the critical pieces where we’ll be able to keep track of who got which vaccine because right now with two vaccines potentially coming down that we’ll be able to administer, we want to make sure that individuals keep up with which vaccine they were administered. So I think that’s a critical point to emphasize that these vaccines require two doses and the second dose, Pfizer will be about 21 days later and the Moderna vaccine will be about 28 days later and they need to receive the same second dose. The second dose notifications and reminders will be important as well.
SPEAKER: (Off Microphone).
JINLENE CHAN: I think that with any ‑‑ any good planner would say you prepare for the worst and hope for the best. We’re prepared for both in that we have providers ready and local health departments are working furiously to put finalization to plans. We know from our experience with H1N1 that the supply can be one week you might get as much as you order and the next week it might not be. We’re expecting that although it is hard to say at this point in time what the actuality will be. We’ll see when the time comes but we have to expect that and that’s what we’re informing our providers is that even though everyone wants a certain amount of vaccine, that we will provide that amount but it may not be exactly the first week that we’ll provide vaccine we get it. It is not our role and not our goal to keep it. We want to get it out there and get people vaccinated.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: I received that report but I don’t think it is accurate. I’ve already talked to the governors with far more hospitalizations and they’re far over. I don’t know what the report was but we’re concerned as mentioned during our last two press conferences that we anticipated we were going to hit peak hospitalizations within a matter of days. We now have. We have to get about three and a half weeks away from Thanksgiving and it will get worse. The modeling shows all of December and January looks pretty rough which is why we put so much emphasis on hiring additional health care personnel, taking care of people until we can get extra hospital beds. As I mentioned earlier, in almost every category, we’re the best in the country.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: I don’t know what happened. I saw the report about the opportunity to get the millions. They’re going through things before purchasing. They wanted to make sure they would be effective. I think we’re seeing great ramp up of production with these two companies and numerous other companies getting close so hopefully there will be enough to go around but obviously it is a very short supply on things.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: We continue to look at the metrics every single day and we’re looking at the data of where the infections are coming from and what actions might help stop them. So far we’ve taken all of the actions we believe should be taken at this point. But there may have to be additional actions as we progress and when we get to that point, where we’ve maxed out our hospital capacity. We’re trying to balance keeping people safe and saving lives and look at the thousands of businesses that are closing and the hundreds of thousands of people that are unemployed. We’re trying to balance the health and economic crisis.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: Yesterday I recruited a group of republican governors to call their republican senators. I’ve been in communication with Senator Warner who’s been taking the lead ‑‑ they’re a big part of the problem solver caucus. I’ve spoken to them four or five times. But they’re part of that problem solver’s caucus. 25 democrats and republicans who have proposed a compromise. I’m rounding up governors and trying to weigh in with senators to try to get them behind it. We still have this republican thing this and democrat thing that but there is a pretty good consensus of people ‑‑ we can’t get what everyone wants but something is better than nothing because in a matter of weeks, we’re going to have no more money to help anyone. They have to take action. So the current compromise will really only take us until March. It is like a 90‑day Band‑Aid. We’ll have to come back to get the major relief packages we’ve been pushing since April through the National Governors Association.
SPEAKER: (Off Microphone).
BRYAN MROZ: We talked about the pyramid, the graduated progression through the phases. The vaccines will be going to very specific locations. Hospitals, nursing homes, pharmacies, CVS and Walgreens, getting them to support long‑term care. As that expands, we’ll have access to the vaccine to start hitting more of the level 1A, 1B level and continue to spread out. What Dr. Chan said is exactly where we need to be in the long run is it will be at the pharmacy, your doctor’s office. That’s where we want it to be in the end but we have to go through the steps and as it becomes more available, it spreads out faster and faster. Local health departments will be running clinics and be part of the process. Absolutely.
GOVERNOR HOGAN: Thank you.
Back in February, I said that I was confident that our state would be a national leader in developing treatments and perhaps even a vaccine for COVID‑19. Researchers at the University of Maryland Medical Center were the first in the United States to begin testing Pfizer’s vaccine. Montgomery County is about to begin phase three trials on their vaccines. Emergent BioSolutions headquartered here and has six sites in Maryland with 1500 employees is manufacturing vaccines for both AstraZeneca and Johnson & Johnson. Nearly 40 Maryland companies have been working on developing and manufacturing COVID‑19 vaccines and innovative therapeutics. Our team at the Maryland Department of Health has worked hard over the past eight months preparing plans to procure, distribute and administer COVID‑19 vaccines when they became available. Our vaccination plan was submitted to the CDC back in October and in November, we committed an additional investment of $1 million for the acquisition of a strategic stockpile of syringes and other necessary supplies for the vaccine. We’ve had regular meetings with the White House coronavirus task force and the leaders of Operation Warp Speed and we’ve been working closely with our hospital systems and our local jurisdictions in order to be prepared for the initial distributions of the vaccine. To be effective, that’s vaccines need to reach a vast majority of our population. And to do so in a relatively short period of time. This is, by far, the most massive undertaking of this pandemic. In order to further prepare our state and to ensure that we’re ready to distribute the vaccine widely, today the Maryland Department of Health has issued an order which expands the scope of practice for licensed providers so that any health care professional including all doctors, nurses, paramedics and pharmacists will be able to administer COVID‑19 vaccines with appropriate training and under proper supervision.
Today’s order also provides that health care providers who are already capable of performing the vaccinations may prepare and administer COVID‑19 vaccines at state‑designated vaccination sites. To help demonstrate confidence in the safety of the vaccine, I want to make it clear that governor Rutherford and I will both take the vaccine in public as soon as it becomes available to us. And we will be leading an aggressive statewide public health campaign urging all Marylanders to vaccinate. While the delivery of vaccines is very welcome news, I would caution Marylanders to remember that our initial allocation would only be 155,000 doses of the vaccine. With the possibility of perhaps up to 300,000 by year’s end.
It is often said that it is always darkest before dawn. Right now, we do remain in a better position than many other states. The ninth best rate and we’re the fourth best mask‑wearing state in the nation with 96.7 percent compliance. However, in spite of all of that success, it is clear that our worst days of this pandemic are still yet to come in the weeks and months ahead. On Friday, we hit a daily record for confirmed cases. We’ve now had 35 straight days with more than 1,000 cases. Maryland’s 7‑day statewide positivity rate is 7.61 percent and our cases per 100,000 is now at 44.8. The death toll continues to climb. The United States is now losing one person to COVID‑19 every 30 seconds or less. The virus has taken the lives of over 283,000 Americans including 4,755 Marylanders. And today, for the first time, since May 22nd, we’ve reported more than 50 deaths in a single day. 1,653 COVID patients are hospitalized today in Maryland which is the highest level since May 9th. 396 Marylanders are currently in intensive care units which is the highest level since June 7th. 85 percent of our staff are occupied and 87 percent of our ICU beds are occupied. 142 surge beds are currently in use at the Baltimore Convention Center field hospital that reopened Laurel Hospital and the expanded Washington hospital, all of which we added this spring. We have now activated our critical care coordination center that allows us to ship patients between hospitals. It has already resulted in the successful placement of 38 patients among 18 different hospitals. We have received an enthusiastic response to our call for medical staffing search. In the first week since I announced it, 4,268 prospects have signed up to work at our hospitals, nursing homes, testing sites and vaccination clinics. Anyone interested in these positions can go to mednow.com. An additional 576 volunteers joined from our Maryland responds med reserve corps which has a total of 15,980 people signed up. More than 1.2 million Marylanders have subscribed to our MD COVID alert contact tracing app which according to Google, is our state’s number one rate in the nation. We are encouraging everyone to opt in to help allow us to stop the spread and protect our fellow Marylanders. Lastly, we’re monitoring active cases at 190 nursing homes and at 132 assisted living facilities. Nursing homes cases remain higher than during the initial spring outbreak.
The Calvary is coming. A vaccine is on the way. But it is absolutely critical that we continue to fight this virus with everything we’ve got and we all need to keep doing the things that we know will help keep us safe. To provide an overview of our plan for the initial roll‑out of the vaccine in Maryland, I’m going to turn it over to Deputy Secretary Chan and Assistant Secretary Mroz.
JINLENE CHAN: Thank you, governor. We are pleased to be here with you this afternoon to give more details about our plans to roll out COVID‑19 vaccinations in Maryland. Since early in the pandemic, we knew that having a safe and effective vaccine would be an important tool to help us save lives. Just as we in Maryland have been working around the clock to respond to the COVID‑19 pandemic through testing, contact tracing, expanding our hospital surge capacity and a multitude of other response efforts, we know that scientist and researchers around the world, here in the United States and even here in Maryland have been working also around the clock to develop and test a vaccine through a phase one, two and three clinical trials.
Now the early data from the first two vaccines being considered in the United States have shown a high level of effectiveness in preventing disease from COVID‑19 and most people involved in the clinical trials have reported minimal side effects. COVID‑19 vaccination implementation will continue to evolve in concert with our federal partners and vaccine manufacturers and we’ll share more information as we have it. What we will discuss today is the information that we have to date based on the planning that we have been doing over many months and I want to turn it over to Bryan Mroz to speak to some of our planning work.
BRYAN MROZ: Thank you, Dr. Chan. Thank you, governor, for giving me the opportunity to discuss this important initiative. Our planning in preparation in Maryland, began ‑‑ started when the pandemic began as early as April, Maryland Department of Health began developing a vaccination plan. By mid‑October, Maryland had submitted our COVID vaccination plan to the CDC. In October, we also started to secure supplies that we knew would be needed for the mass vaccination efforts.
In November, we began convening our advisory groups, technical, minority health, vulnerable population and other outreach groups. Also in November, Governor Hogan announced a $10 million in additional funding to secure ancillary supplies such as syringes, personal protective equipment and freezers. These are a few of the ways in which Maryland has been preparing for the vaccine. Preparations were also occurring on the national level. Multiple pharmaceutical companies began developing vaccines months ago. Clinical trials occur in three phases and in the last phase, tens of thousands of volunteers. Once it demonstrated a high level of efficacy and safety, the pharmaceutical companies can then apply for an emergency use authorization. So far only two manufacturers applied for this emergency use authorization. Currently these two companies are manufacturing millions of doses in anticipation of federal approval. The federal department has prioritized these for delivery across the United States. Once approved, these allocations will be shipped directly to the providers such as hospitals, pharmacies and clinics.
In addition to distributing the vaccine, the federal government is shipping the ancillary supplies associated with administration. This entire development distribution process is monitored and staffed by the FDA, the CDC to maximize security. With security and efficacy in mind, I wanted to bring Dr. Chan back up to discuss the two candidates that have applied for authorization.
JINLENE CHAN: Thank you, Bryan. So as you’ve heard, there are two candidates. The first one is from Pfizer. Some of the early data that they released in early November from their phase three clinical trials suggest that there is 94 percent to 95 percent efficacy in the risk among people who got the vaccine compared to people who did not get the vaccine or who got the placebo. This also was highly effective even among individuals who were older. And the results were after the second dose. Both vaccines require two doses for maximum efficacy. It is important to note that in some of the early information provided by Pfizer that even in preventing severe disease, it is closer to 100 percent. Again, on‑going information and tracking of individuals who participated in the trial will continue to identify potential side effects as well as clinical outcomes. Pfizer submitted on November 20th their application to FDA for an EOA approval and later this week on December 10th, the FDA’s advisory committee will be considering the data and make a recommendation to the FDA on whether to approve or not. In the time frame since Pfizer submitted their application, the FDA has been carefully considering the data that has been submitted and so our FDA’s process in considering any vaccine application is that they independently analyzed the data that’s submitted to them by the vaccine manufacturer coming out of all of the clinical trials so that they could make an independent determination not only about efficacy but also about side effects and other impacts within the volunteers who participated in the trial. If approved, which we anticipate it will be, we believe that the initial doses of the Pfizer vaccine will become available for Maryland as early as the week of December 14th or next week.
Now Moderna is the second vaccine that has submitted their application to the FDA for EOA approval. Early data that Moderna has released shows it also has similar efficacies to the Pfizer vaccine with about 94 percent efficacy. They applied on November 30th and the FDA’s advisory committee has already scheduled a meeting to consider their vaccine data on December 17th which the anticipation that, if approved, then the week after on the week of December 22nd, that Maryland will be able to receive the Moderna vaccine for use.
So as Maryland has considered how to best allocate the initial vaccine doses, we’re taking into account a number of key priority considerations. First, our federal recommendations with our federal partners, CDC just last week, their advisory committee on immunization practices, on Tuesday released their initial recommendations to the priority grouping for stage 1A to include health care workers and the residents of long‑term care facilities. Long‑term care facilities would include nursing homes as well as assisted living. We have also considered the groups at highest risk for complications or deaths from COVID‑19 and as many people know and the governor has indicated, nearly half of our deaths have occurred in individuals in nursing homes and we currently have 190 active outbreaks in nursing homes and over 130 in assisted living. So these are among the highest risk groups in Maryland. It is also critical that we preserve our health care capacity and that has been in consideration for the entire course of the pandemic and more recently we issued a number of orders and guidance with the intent of maximizing our ability to deploy our critical health care infrastructure to be able to care not only for individuals with COVID‑19 but people who come to seek health care or other conditions whether in the hospital or in outpatient status. So as seen in this graphic, our approach in Maryland will be to include in that phase 1A all health care workers, long‑term care facility staff and residents as well as first responders. That will include nursing homes as well as assisted living where we have had, as we’ve mentioned, a significant impact. As we receive more vaccine in the weeks and months to come, we will continue to expand the groups who are able to access the vaccines including high‑risk such as those with chronic pulmonary disease, chronic kidney disease or heart conditions and also adults in other congregate settings. We’ll move quickly into phase 2 which will include people who work in other critical essential infrastructure settings and be able to open the vaccinations up for them.
And ultimately, our goal in Maryland is to make sure that COVID‑19 vaccine is available for every Marylander who wishes to have it. As we approach phase 1, we will be focusing primarily on the vaccination of the high‑risk population. Again, in alignment with the federal guidance. We anticipate that after the FDA approves each of the vaccines, that the CDC’s advisory committee on immunization practices will reconvene to provide additional guidance and information specific to the Pfizer and Moderna vaccines based on the detailed data analysis they will have done. The CDC will provide us with information as we go forward on the number of doses as that will have available week after week. While we expect that limited availability initially, we do believe that we will continue to get doses not just in the first week but in the second week and in the weeks and months to come. Phase 2 will begin when targets for phase 1 have been met which will include factors including whether most of the target population have been actually offered or made an opportunity to have a vaccine or to be vaccinated. Then expansion into phase two will include those workers, as I mentioned, who work in the critical infrastructure settings such as in education, transit, utility workers and others.
Our vaccination efforts will continue until all Marylanders are able to access the vaccine. As noted, Maryland will align with federal recommendations as much as possible. So we have now received word from the CDC that the state will receive approximately 155,000 initial doses from the Pfizer and Moderna. Pfizer, we anticipate we will be getting 50,000 doses and because Pfizer will likely be the first vaccine to be approved, those will be able to come into the state and be used first. Moderna has provided 104,000 for the state of Maryland in the first allocation. And that will come to the state once that is approved. Now based on the considerations we have discussed, the state has decided to divide our initial allocations among the groups that have the most ‑‑ the highest risk that we have seen in the state to start with hospital‑based health care workers and nursing home staff and residents. These are only the first doses that we will receive and more will continue to come week after week and provide ‑‑ we’ll be able to provide those to hospitals and to nursing homes. Of note, with the long‑term care facilities including nursing homes and assisted living, the state of Maryland has signed up for the CDC pharmacy program which is a partnership that the federal government has contracted with CVS and Walgreens to be able to administer vaccines in those settings. We’re engaging with both of them to make sure our efforts are coordinated. And in fact, all nursing homes and assisted living have been signed up on their behalf. They have the option to opt out. That we would certainly encourage all of them to participate in the program so that there is a workforce available to actually administer vaccines in their settings again to the highest risk individuals there.
As the vaccine becomes more available, we’ll follow our allocation and distribution plans and begin to distribute to local health departments who will be able to make the vaccine available for first responders and others going forward. I would now like to ask Bryan to come back up and discuss some of the logistics of vaccine ordering and distribution.
BRYAN MROZ: Thank you, Dr. Chan. In terms of ordering vaccines, we’ll be using ImmuNet. It is the cornerstone of Maryland’s immunization information system. Providers will place orders in ImmuNet. It will go to the federal government and the federal government will then distribute those vaccines directly to the provider. ImmuNet is also used to store vaccine records. ImmuNet is HIPAA compliant and is used to safely and securely manage personal health information associated with vaccines and immunization. ImmuNet has been used in Maryland for over 15 years and is currently used to store every record of vaccines administered in Maryland. We’ll be using it for COVID but we also use it for non-COVID. We’ve enhanced the capabilities and capacity of ImmuNet to handle the additional information expected with the COVID pandemic. We talked about storing the records but let’s say someone wants their own record. Can they get it? The answer is yes. We have established a consumer access portal. An individual who has been administered a vaccine, even currently, can go to MD.MyIR.net and download their own vaccination records.
So we’ve talked about storing records but let’s talk about storing the vaccine. I know there are a lot of questions about this. As many of you know, the vaccines will come to us frozen. They will come shipped frozen. Pfizer vaccine is minus 80 degrees Celsius. Moderna will be shipped at minus 20 degrees Celsius. Most providers of vaccines already have the ability to store vaccines at minus 20 degrees so that leads to minus 80 degrees Celsius. To make sure they remain frozen, Pfizer has created insulated containers that you can see in this picture. It looks like a shipping container. There is insulation and dry ice with the vaccine and the dry ice on top. It is about the size of a suitcase and weighs about 70 pounds. It is GPS track and the temperature is constantly monitored. Dry ice can be reloaded to assure that it is the correct temperature. If we wish to store it in the shipping containers, they can last for weeks as long as we continue to reload the dry ice. If we do not want to use these containers to store them in, they would have to be stored in freezers specifically designed for ultra-low cold temperatures. As you can see from the picture, this is an example of what one of the refrigerators looks like. The state has secured several of these freezers to make sure we can store in addition to that, we have contracted with institutions and organizations that have ultra-low cold storage capability and we have established contracts with multiple vendors with dry ice supplies. We feel confident we can handle the storing of the vaccine either in the shipping containers or in ultra-low cold storage.
I would like to move on to another concern that has been mentioned which is vaccine confidence. The governor spoke about that. He’s willing to be one of the first to step up to take it. While we recognize there is vaccine hesitancy out there and we’re committed to hearing these concerns, the governor is committed to on‑going statewide communication that will be led by Governor Hogan. We will work on local outreach and collaborative with trusted community leaders and voices to understand community hesitancy. We will communicate what we know and what we don’t know. We will share safety information such as side effects in a language and style that is easily understandable. We feel that the best way to build confidence is open communication. And this comes with a caution. We are already aware that there are rumors, misinformation circulating on social media. We asked everyone to get their information from trusted sources that are based on facts and science. We know there are questions out there and I would like to invite Dr. Chan back up to address the common questions that have already been raised.
JINLENE CHAN: Thank you, again, Bryan, for talking through the logistic aspects of our vaccination plans. We know that there are many questions out there and that you have questions as well. So I want to address some of them that I know are front and center for health care workers and for our community. And so one question is about the safety of the vaccine. And what we know from the vaccine trials is Pfizer enrolled 40,000 people which is quite a large vaccination trial and Moderna enrolled about 30,000 individuals with some significant effort to ensure diversity and the people that were involved in terms of age, race and ethnicity. As I mentioned earlier, it appears that among all of those groups and I believe Pfizer just released ‑‑ I’m sorry, FDA just released Pfizer’s data earlier today but we believe that the efficacy is consistent across different age groups as well as race and ethnic. However, side effects are important to understand and so these vaccines, among the people who receive the vaccine, they did experience some mild side effects but most people did not. Some of the side effects that people did experience were primarily in the first one to two days after receiving the vaccination and as one might expect, pain at the site of the injection, mild fever, headache, muscle aches and joint aches as well. And this shows actually that the vaccine is working. The body’s immune system was responding to the vaccine to be able to produce the protective antibodies that would protect the individual. Another is that there are groups that are monitoring the results at every step of the way. For both Pfizer and Moderna, their data monitoring communities did not flag any safety concerns throughout the course of the vaccine trials to date and they will continue to monitor the follow‑up of the individuals enrolled in the vaccine trials for at least another couple of years. So that’s important to understand. We know that the early information about side effects, about 10 percent to 15 percent of people in the early reports may experience mild to moderate impact, back to the pain at the site of injection and some headaches and fever and muscle or joint aches.
Another question that people have asked is is the vaccine safe for children? That’s a really good question. Right now, the vaccine trials have only been done in adults. So it is anticipated that any EOA approval or recommendations from the CDC will only be for adults at this time. However, the clinical trials have already started to enroll children as young as 12 and will be enrolling younger children. We anticipate that the results from future trials will provide us more insight into the efficacy and safety in children. Another question is will I need to be vaccinated every year? At this point, we do not know how long the immunity will last. There are some who suggest there may be a need to get a vaccine or a booster similar to a flu vaccine once a year. At this time, we do not know whether or not that will be necessary. Again, as we follow the individual through the trial, we’ll be able to have more information and provide those answers to you. Another question, do I need to keep wearing a mask after I get vaccinated or keep social distancing? That’s front and center on everybody’s mind. The vaccine will protect the person who is getting vaccinated from getting the disease but it is still important and we believe it will still be important for everyone to wear a mask and practice safe social distancing and hand washing to prevent potential transfer or spread of the disease to people who are unvaccinated.
And then when can I pre‑register for the vaccine? I know many Marylanders are ready to get the vaccine and want to learn more information about the vaccine and in the coming weeks, we will be rolling out more information as well as a mechanism for Marylanders to actually pre‑register and sign up for an appointment. Again, as we move into phases two and three, we’ll be able to have that available for all. I know that there are many other questions and we commit to providing Maryland with updates. So thank you and I will turn it back to you, Governor.
GOVERNOR HOGAN: Thank you, both. We’ll open it up to questions. The experts will handle the hard ones and I’ll answer the easy ones.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: I totally understand the fact that there are a lot of people out there that don’t trust it. I’m not sure who said it about we want to engage in a micro, local level. Community leaders and people that will help convince others that it is safe. We’re going to be doing it ourselves but we’re going to engage people in every community to help with that convincing.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: That’s a great question. The answer is the 155,000 doses are the initial allocation and the federal government is holding back the second batch of those 155,000. It is not half of the 50,000 and we have to hold them. We’ll get the first batch and we’ll get the second batch later and the additional capacity to do additional people.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: Yes. One shot of the two shots needed. The second shot which we’ll get within the time frame that they need to get the second shot.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: We’ve had assurances from everybody at the federal level and Operation Warp Speed and so far they’re ahead of schedule so I’m hoping that will continue.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: We have an incredible process here in the country. I can assure you that all of the people who know more than I do have done quite a bit of studying and they believe it is safe. I have had conversations with all of the leaders as I mentioned, the coronavirus task force and Dr. Fauci and Dr. Birx and Dr. Redfield from the CDC and everybody involved believes it is safe and very effective, more effective than any other vaccine even in history and that’s going to help us save a lot of lives so I don’t have any hesitation at all.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: What we think is we’re going to get 300,000 by the end of the month which is pretty fast. Coming out every week if things go coordinate according to plan. We have about that many frontline workers. It will be limited to the 1A group as they were describing the pyramid. The production will ramp up for both Moderna and Pfizer but we also have the other numerous other companies that are getting close to having their vaccine available. So the hope is that we’ll have similar success with some of the other companies including the ones I mentioned here in Maryland with AstraZeneca and Johnson & Johnson working together with Montgomery County and others so that we’ll have a growing supply coming from different places and different manufacturers.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: Maybe that’s something Dr. Chan wants to address but we don’t have an intention of requiring the vaccines but we’ll do everything we can to encourage. I don’t know if you want to talk about kids and schools.
JINLENE CHAN: Thank you for that question. As I mentioned in my remarks, the clinical trials right now are just getting underway for children so we have very little information about what the efficacy and side effects for children will be. When that time ‑‑ and also I guess the other important component is that the vaccine will be approved under an emergency use authorization which has the same rigorous look at all of the data as through a normal process but because we’re in a state of emergency and because we have individuals being hospitalized and dying from COVID‑19, this is a very expedited review process. So I think down the road, there may be considerations for that but it would be premature right now to make that a mandatory requirement.
SPEAKER: (Off Microphone).
JINLENE CHAN: We communicate on a regular basis. We call each other every single week to talk about how the pandemic is evolving and the impact on schools and school children. The guidance we issued back in August, we are looking at new information that’s coming out to assess whether or not there may be a need for changes. However, the other question is about how is the guidance. I believe within certain settings, there may be an opportunity to bring children back in small, limited groups and particularly children who have ‑‑ who have had more difficulty with distance learning or those with special needs.
SPEAKER: (Off Microphone).
JINLENE CHAN: I believe, if I remember correctly and I think it is around 800,000 in the 1A population, we believe that is the case. So as we get vaccines, we’ll start with the highest risk so within hospital settings, and then in nursing homes and as we get more vaccines, as we complete the vaccinations of those groups of individuals and we get more vaccines, we’ll be able to expand the number of people and the groups that are able to access the vaccine with assisted living, with other health care providers including in outpatient settings and first responders. So we’re going to move as quickly as we can through each of the priority groups so that we are sure that all health care workers have the opportunity to be vaccinated.
SPEAKER: (Off Microphone).
JINLENE CHAN: Absolutely. There are various considerations in terms of how we begin to allocate vaccines to different groups. Certainly a number of people, it doesn’t make sense to give a Montgomery County or Baltimore County fewer doses than a county out in western Maryland, for example. So those were some of the considerations. Some of it will be dependent also on the logistics involved. As you heard, from Bryan, the Pfizer vaccine requires the ultra-cold storage and very, very careful handling so that will also be a consideration about who can manage it and who can handle the types of vaccines that will be available. Again, these are only the first two we know of and we have a lot more information about these than the others that are currently in phase three or in earlier phases of trials.
SPEAKER: (Off Microphone).
JINLENE CHAN: That’s a great question. In the early phases, we’re directing our vaccine to facilities primarily and also working closely with local health departments who have had years of experience in doing vaccination clinics. Some of them have done mass vaccination clinics for many years so the process is similar in that way. However, as we receive more vaccines, we’ll be opening up in the coming weeks, the registration portal for providers in ImmuNet to be able to register to order and receive COVID‑19 vaccines. So those providers will include pharmacists, primary care providers, urgent cares and others. So ultimately, the goal when we’re able to reach phase three, that we have sufficient vaccines of potentially multiple different kinds that providers can put in an order through ImmuNet and we can pull fill the order, submit that to the CDC and the vaccine would be sent to them. That’s how Marylanders will be able to access that.
SPEAKER: (Off Microphone).
JINLENE CHAN: Correct. Each of the vaccine kits that are coming from the manufacturer and the CDC will actually come with a paper record as well. It is important for people to know and Bryan alluded to this in his remarks that through ImmuNet and through MD.MyIR.net are the critical pieces where we’ll be able to keep track of who got which vaccine because right now with two vaccines potentially coming down that we’ll be able to administer, we want to make sure that individuals keep up with which vaccine they were administered. So I think that’s a critical point to emphasize that these vaccines require two doses and the second dose, Pfizer will be about 21 days later and the Moderna vaccine will be about 28 days later and they need to receive the same second dose. The second dose notifications and reminders will be important as well.
SPEAKER: (Off Microphone).
JINLENE CHAN: I think that with any ‑‑ any good planner would say you prepare for the worst and hope for the best. We’re prepared for both in that we have providers ready and local health departments are working furiously to put finalization to plans. We know from our experience with H1N1 that the supply can be one week you might get as much as you order and the next week it might not be. We’re expecting that although it is hard to say at this point in time what the actuality will be. We’ll see when the time comes but we have to expect that and that’s what we’re informing our providers is that even though everyone wants a certain amount of vaccine, that we will provide that amount but it may not be exactly the first week that we’ll provide vaccine we get it. It is not our role and not our goal to keep it. We want to get it out there and get people vaccinated.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: I received that report but I don’t think it is accurate. I’ve already talked to the governors with far more hospitalizations and they’re far over. I don’t know what the report was but we’re concerned as mentioned during our last two press conferences that we anticipated we were going to hit peak hospitalizations within a matter of days. We now have. We have to get about three and a half weeks away from Thanksgiving and it will get worse. The modeling shows all of December and January looks pretty rough which is why we put so much emphasis on hiring additional health care personnel, taking care of people until we can get extra hospital beds. As I mentioned earlier, in almost every category, we’re the best in the country.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: I don’t know what happened. I saw the report about the opportunity to get the millions. They’re going through things before purchasing. They wanted to make sure they would be effective. I think we’re seeing great ramp up of production with these two companies and numerous other companies getting close so hopefully there will be enough to go around but obviously it is a very short supply on things.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: We continue to look at the metrics every single day and we’re looking at the data of where the infections are coming from and what actions might help stop them. So far we’ve taken all of the actions we believe should be taken at this point. But there may have to be additional actions as we progress and when we get to that point, where we’ve maxed out our hospital capacity. We’re trying to balance keeping people safe and saving lives and look at the thousands of businesses that are closing and the hundreds of thousands of people that are unemployed. We’re trying to balance the health and economic crisis.
SPEAKER: (Off Microphone).
GOVERNOR HOGAN: Yesterday I recruited a group of republican governors to call their republican senators. I’ve been in communication with Senator Warner who’s been taking the lead ‑‑ they’re a big part of the problem solver caucus. I’ve spoken to them four or five times. But they’re part of that problem solver’s caucus. 25 democrats and republicans who have proposed a compromise. I’m rounding up governors and trying to weigh in with senators to try to get them behind it. We still have this republican thing this and democrat thing that but there is a pretty good consensus of people ‑‑ we can’t get what everyone wants but something is better than nothing because in a matter of weeks, we’re going to have no more money to help anyone. They have to take action. So the current compromise will really only take us until March. It is like a 90‑day Band‑Aid. We’ll have to come back to get the major relief packages we’ve been pushing since April through the National Governors Association.
SPEAKER: (Off Microphone).
BRYAN MROZ: We talked about the pyramid, the graduated progression through the phases. The vaccines will be going to very specific locations. Hospitals, nursing homes, pharmacies, CVS and Walgreens, getting them to support long‑term care. As that expands, we’ll have access to the vaccine to start hitting more of the level 1A, 1B level and continue to spread out. What Dr. Chan said is exactly where we need to be in the long run is it will be at the pharmacy, your doctor’s office. That’s where we want it to be in the end but we have to go through the steps and as it becomes more available, it spreads out faster and faster. Local health departments will be running clinics and be part of the process. Absolutely.
GOVERNOR HOGAN: Thank you.