A large percentage of nursing home workers in D.C., Maryland and Virginia have declined to take the coronavirus vaccine, officials say, presenting a major challenge in the region’s plans to protect its most vulnerable residents.

Nursing home workers were first offered the vaccine in late December and early January, along with residents of long-term care facilities and other health-care workers. Their wariness, providers and union representatives say, is fueled by online misinformation about the vaccine and historical mistrust of the medical system of which they are a part.

In the meantime, other members of the public are scrambling for the limited supply of vaccine doses available to them, with many elderly adults and some essential workers unable to find appointments or having their time slots canceled in recent days.

Health-care workers across the U.S. received their first dose of the Pfizer-BioNTech coronavirus vaccine following its Dec. 11 authorization by the FDA. (The Washington Post)

In an internal document obtained by The Washington Post, Maryland health officials said that as of Tuesday, only about 58 percent of the doses allocated to nursing home staff and residents had been administered — even though vaccination clinics have been conducted at every facility. Tredonna Kum, an administrative organizer for 1199 SEIU, which represents nursing home workers in Maryland and D.C., estimated that up to 80 percent of members chose not to be vaccinated during the first wave of clinics.

“One of the surprises in the first three weeks was that in health care and in the nursing homes, there was about a 35 to 50 percent uptake. . . . We had expected closer to 80 or 90 percent uptake,” Maryland’s acting health secretary Dennis R. Schrader told state lawmakers this week.

Veronica Sharpe, president of the District of Columbia Health Care Association, said the vaccination rate among nursing home staff has been about 40 percent — less than half the rate of those who live in the facilities. Industry representatives in Virginia said they’ve seen similar trends, though state health officials declined to say exactly what percentage of nursing home workers have been vaccinated.

Representatives for CVS and Walgreens, which have partnerships with long-term care facilities in all three jurisdictions, also said vaccine uptake among employees has been less than expected. CVS spokesman T.J. Crawford said the company tells the state government when it needs fewer doses than initially anticipated. If the company has extra after staging a clinic for a particular nursing home, it reroutes those doses to other facilities.

In North Carolina, the top public health official said in early January that most nursing home workers had declined the vaccine. In Ohio, more than 60 percent of nursing home workers opted out during the first wave of vaccination clinics, said Gov. Mike ­DeWine (R). Officials in Connecticut have reported similar numbers.

David Grabowski, a Harvard University health policy professor, said the numbers shouldn’t surprise anyone familiar with long-term care facilities, where low wages and poor labor conditions — and earlier missteps fighting the coronavirus pandemic — have created a well of mistrust, especially among the Black and Latino workers who dominate the industry.

“This is a forgotten workforce that hasn’t been treated well for years,” Grabowski said. “We’ve been slow with [personal protective equipment], we’ve been slow with hazard pay, and all of a sudden now, they want to go fast with vaccinations. . . . There’s good reason they’re so distrustful.”

Joseph DeMattos, president of the Health Facilities Association of Maryland, said federal government outreach to nursing home workers about the vaccine was “grossly underwhelming.”

Although the Maryland Department of Health has been “rightfully focused” on the logistics of vaccine rollout, he said, it “missed early opportunities to partner and communicate with diverse communities the imperative to take the vaccine when it was first offered.”

The Maryland Baptist Aged Home in West Baltimore was among the first nursing homes in the state to receive vaccine doses. When CVS conducted a clinic on Dec. 23, only 11 of 41 employees agreed to be injected.

“I was shocked, I mean, just shocked,” said the Rev. Derrick DeWitt, director of the facility, which barred visitors and tightened infection-control precautions in late February and has reported no coronavirus cases among staff or residents.

DeWitt said he called dozens of the facility’s workers and found many had been influenced by online misinformation about the vaccine and mistrust of the medical establishment, fueled by historical abuses like the Tuskegee syphilis study and the ongoing lack of access to medical care in Baltimore’s communities of color.

“These folks don’t even have access to a doctor when they’re sick. Then suddenly you say, ‘Show up in a parking lot and get this mysterious vaccine.’ It’s hard for them to trust you,” DeWitt said. “People of color have become very pessimistic about being guinea pigs.”

After that first clinic, DeWitt said, he “used everything in my arsenal” to get his staff to change their minds. He invoked his trustworthiness as a pastor, narrated facts about the vaccine over the nursing home’s public announcement system and reminded staff that nothing had happened to him or the others who had been vaccinated.

During the facility’s second clinic in mid-January, 26 of the remaining 30 employees were willing to get their first shots.

Among them was a registered nurse from Baltimore who spoke on the condition of anonymity to discuss a private medical decision. She was initially worried about the vaccine, especially because she had heard about how quickly it had been created, she said. But after considering her job and the escalating infection rates in the region, she decided it was worse to stay exposed to the virus.

“Based on all that they were saying, I assumed it’s okay,” she said in a telephone interview. “I mean, in this world, nothing is sure.”

Many employees at Trio Healthcare’s 11 nursing homes in Virginia, especially in rural parts of the state, initially bought into various myths about the vaccine, said Chief Clinical Officer Melissa Green. These included erroneous rumors about serious side effects, she said, and unproven conspiracy theories about government plans to microchip residents.

It took an active internal campaign that involved fact sheets and posters of employees getting the shots to persuade 80 percent of the staff to be vaccinated, Green said.

When it comes to communicating with workers, it’s not just the information that matters, but how it is delivered, said Grabow­ski, the Harvard professor. “Web­inars or FAQs” are not going to be as effective, he said, as a conversation with a trusted source.

After geriatric nursing assistant Davenia Kemp received her first dose of the vaccine on Dec. 23, in a celebratory news conference attended by Maryland Gov. Larry Hogan (R), she faced questions from other employees at Franklin Woods Center in Baltimore County about whether they should follow suit.

“They had heard about bad side effects and bad experiences,” said Kemp, 25, of Baltimore City. “I told them, ‘I feel fine, I feel great.’ ”

Sharpe, the D.C. industry representative, said the city’s nursing homes have tried to discuss the vaccine with workers one-on-one, rather than in big staff meetings. Providers are looking to identify natural leaders among the staff — whether or not they are supervisors — and asking them to encourage their peers to take the vaccine. Some facilities are also offering incentives. One is entering vaccinated employees in a raffle with monetary prizes.

At one D.C. nursing home that had its second clinic this week, the percentage of staff getting vaccinated increased from 30 percent to 80 percent, Sharpe said. She did not name the facility.

Keith Hare, president of the Virginia Health Care Association, said vaccine uptake is also improving among that state’s nursing home staff in the second wave of clinics, many of which are occurring this week. He said wary employees are more likely to feel comfortable once they see that colleagues vaccinated weeks earlier are healthy.

Some local providers, such as Lutheran Social Ministries of Maryland, are taking a stricter approach: requiring their employees to take the vaccine. After the first round of clinics at two facilities in Carroll and Howard counties, more than 50 percent of all staff had been vaccinated, and more are expected to sign up for the second round.

“It’s ultimately their choice,” said Ken Connelly, vice president of operations. “But if they choose not to get the vaccine, we’re going to amicably part ways. . . . The only way we get back to normal is getting everyone vaccinated.”

Such mandates have drawn opposition elsewhere. At a Wisconsin facility, some workers quit after being told they had to be vaccinated, one employee told a local television station. In Pennsylvania, a health-care union is pushing back on a facility’s decision to require the vaccine.

It’s critical for health-care providers to get inoculated because they can help foster confidence — or doubt — in the vaccine among members of the public, particularly in their own communities, said Lyda Vanegas, a spokesperson for Mary’s Center, a network of clinics that serves primarily Latino residents in D.C. and Maryland. The center has vaccinated about 60 percent of its 700 staff, Vanegas said, urging them to take pictures of themselves during the process as a way to “spread excitement.”

Rebecca Moralez-Fairbanks, administrator of Beth Sholom Village in Virginia Beach, said getting vaccinated was the only way to protect residents she interacts with, including her parents, who live in the facility’s assisted-living center.

She’s done everything she can think of to encourage other employees to follow suit, including distributing information about what is in the vaccine and possible side effects. As of Tuesday, 75 percent of her employees had gotten vaccinated.

“We are the ones bringing it in,” she said. “So we need to be the ones stepping up and preventing illness.”

The day she received her first vaccine, she said, was the best she has had since the pandemic started.