Amid concern that prioritizing speed has heightened vaccine inequity statewide, Prince George’s County stands out: The majority-Black suburb has by far the most coronavirus cases in Maryland, and the lowest percentage of vaccinated residents.
Gov. Larry Hogan (R) has repeatedly cited vaccine hesitancy among minority groups as the key cause for the lagging rates, saying at one point that African American and Latino residents in Prince George’s, who represent 84 percent of the county’s population, are “refusing to take the vaccine.”
But local, state and federal leaders from across Maryland — all of them Democrats — blame the state’s decentralized sign-up system, which they say prioritizes those with more time, technology and information at their disposal over those who are disproportionately dying.
In interviews, more than a dozen vaccine-seeking Prince Georgians agreed.
“I want the vaccine because I need it,” said Mae Grey, the partially blind resident who spent weeks trying to get an appointment before securing one for Friday. “I thought it would be easy, because I am 81.”
“If it’s going to keep me here, then I am 100 percent for it,” said Clementine Ruffin, the 102-year-old, who was vaccinated recently after nearly a month of waiting. “I was enthusiastic, gung-ho.”
Statewide, Black people represent 31 percent of Maryland’s population but only 16 percent of vaccine recipients for whom race has been reported. That disparity has grown wider over the past two months, according to a state analysis. But a Goucher College poll released Monday shows vaccine hesitancy decreasing in recent months, with about 31 percent of White Marylanders and 36 percent of Black state residents wary of being inoculated.
Prince George’s lags far behind other counties, with just 8.3 percent of residents having received their first shot as of Thursday.
Nearly 120,000 residents have signed up for the county’s vaccine waiting list. But some clinics in the county — including the mass vaccination site at Six Flags amusement park — have been swarmed by people from neighboring jurisdictions.
“We . . . ask that officials not hide behind the veil of vaccine hesitancy and disparage a community that is eager and anxious to receive the vaccine,” said George Askew, who is helping lead vaccine distribution efforts for Prince George’s.
Stephen B. Thomas, head of the Maryland Center for Health Equity at the University of Maryland, said Hogan should stop “blaming the victim.”
“The people who control the system,” he said, “need to be more empathetic with the people who have lost all hope in the system.”
An equity task force Hogan created released plans on Thursday to target underserved communities with pop-up clinics and other efforts, and solicit ideas from community groups about how best to deliver vaccine doses. The governor acknowledged the state was “not where we need to be with the Black community or the Hispanic community.”
But Hogan also said he believes the state has done far more than others to acknowledge and address racial inequity in vaccine distribution.
“I’m not going to respond to every criticism of every person who does not like what we say or do,” he said.
He had previously said that Prince George’s and Baltimore City — the state’s two majority-Black jurisdictions — were receiving more doses per capita than other jurisdictions, which local leaders dispute because the tallies include large hospital systems located within their borders that inoculate people from many different places.
Recently, the governor outraged Democratic lawmakers when he said Baltimore City was receiving more doses than it was “entitled to.”
“If vaccine distribution were equitable, we’d see consistent vaccination rates across racial lines,” Baltimore Mayor Brandon Scott (D) said in an interview. “That’s not what we see. . . . Black and Brown people are the ones who are dying at a higher rate in this state. You should absolutely be doubling, tripling, quadrupling vaccines to that community.”
Prince George’s County Council member Deni Taveras (D-District 2), who represents some of the hardest-hit areas in the suburb of 900,000 people, called it “irresponsible” for Hogan to talk about mistrust without investing more time, money and effort in educating people who have reservations about getting vaccinated.
“He is using that as an excuse as to why he does not have to vaccinate people of color with the same urgency as other communities,” Taveras said.
At a public hearing Wednesday, County Executive Angela D. Alsobrooks (D) said she was glad to see the state has dramatically increased the allotment of vaccine doses going each week to the Prince George’s health department. But she called on Hogan to do more, including reserving specific days at Six Flags for Prince Georgians and opening another site at the University of Maryland.
Hogan said he was considering it.
His spokesman, Michael Ricci, noted that federal guidelines call for vaccine distribution based on population, not which counties are hit hardest.
Public health experts say that unwillingness to get vaccinated among Black residents is a real concern, rooted in decades of distrust in the medical establishment. But they said it can distract attention from a larger problem in many communities: how to equitably distribute a scarce supply of shots.
“Hesitancy certainly is a factor in our communities,” said Leana Wen, an emergency physician who previously served as Baltimore’s health commissioner. “What bothers me so much is that it is used as an excuse to justify low rates of vaccination, rather than to understand that the real issue for many is around access.”
The Hogan administration, as well as local leaders in Baltimore and Prince George’s, have tried to address some of the access issues, sending mobile vaccination clinics into senior housing, setting aside appointments for local residents, visiting churches, and calling, emailing and texting people on the health department wait lists.
The state also tried to contact Prince Georgians about appointments set aside for them at Six Flags. But only 28 percent of the phone calls were answered at first. When the state started texting people instead, in late February, they lined up 370 appointments over two days.
“I don’t believe it’s an issue of hesitancy,” Maryland National Guard Brig. Gen. Janeen L. Birckhead, who leads the equity task force and dispatched a sound truck to Prince George’s to promote vaccines, recently told state lawmakers. “I believe it’s an issue of technology and getting to people where they are.”
Grey, the 81-year-old woman who got a vaccination appointment for Friday, is blind in one eye following multiple strokes. She lives by herself and did not know about the Six Flags site until she turned on the news last month and saw a massive line of cars filled with people waiting to get vaccinated.
“I said, ‘How in the world did people know about it so quick?’ ” said Grey, who only leaves her house for doctor appointments and has multiple relatives who have contracted the coronavirus.
On the morning the site opened, 10,000 appointments were snapped up within 20 minutes. Over the next few weeks, most appointments went to residents of nearby counties with much smaller Black populations. Even with 500 appointments a week set aside for Prince George’s residents, they obtained just 11 percent of appointments overall.
A similar dynamic has played out in Baltimore, where more than 60 percent of all vaccine doses distributed in the city have gone to people who live outside its borders, according to a city analysis of state health data released by Scott’s office.
“The issue is less about hesitancy and more about actual access to the vaccine,” the mayor said. “People are asking for the vaccine. They’re emailing us, they’re contacting us on social media.”
Among the Black Prince Georgians who spent weeks trying to secure an appointment was Gail Carter, 69, who preregistered herself and Ruffin, her centenarian friend, on the county website. She also signed them up with CVS and Walgreens and regularly checked Six Flags for appointments.
Ruffin, a retired nurse who lives by herself in Capitol Heights, does not have a computer or a smartphone. She desperately misses the senior galas where she used to dance before the pandemic, and she knew she wanted a shot as soon as they were available. In one week last month, the church she has attended for decades held three funerals for covid-19 victims, underscoring the urgency.
“I said yes because it is important — it will make life longer,” she said.
When no confirmation emails were forthcoming, another friend sought help from a state senator, to no avail. Eventually, Ruffin got a call telling her she could receive her first shot Feb. 25 at a Walmart in Clinton, one of the pharmacies the state has partnered with.
Bowie resident Kareem Abdus-Salaam registered his mother, an 83-year-old breast cancer survivor, nearly a month ago. A prominent real estate developer in the county, he has been regularly calling the health department and his county council member but still has not received an email from the health department telling him appointments are open.
Almost every morning, he said, his mother, Carolyn Keith, asks, “Do I need to call to get my vaccine today?” He replies: “We just have to wait.”
LaShawna Saint-Preux said her 94-year-old grandfather, who lives in Capitol Heights, was so tired of waiting for an email from the county’s health department that he started vaccine hunting on his own, getting turned away from the county site in Landover because he did not have an appointment.
The elderly man, who did not want his name used for privacy reasons, also showed up at a food giveaway hosted by Prince George’s County Council member Jolene Ivey (D-District 5), hoping the line he saw meant they were dispensing vaccines.
In the end, Saint-Preux said, he got vaccinated by showing up at Walter Reed National Military Medical Center in Montgomery County.
Among those getting their shots at Six Flags on a recent day was Alicia Levin, a 64-year-old private schoolteacher from Rockville who said she had been waking up at 5:30 a.m. every day trying to get an appointment. Her husband drove nearly two hours to St. Mary’s County to get his shot.
Levin, who is White, said she worried about the possibility of taking away a shot from a health-care worker from Prince George’s. But after her mother-in-law died of covid-19, she wanted to do whatever she could to get inoculated.
That’s a choice that public health experts and ethicists say makes sense, and for which people should not be blamed. They said it is the responsibility of the government to target those who most need the vaccine — and not to fault them.
Thomas, the U-Md. equity expert, said politicians focused on assigning blame risk failing to tackle the ways in which institutional racism has shaped the current reality, with Black and Latino residents having less access to high-quality health care and healthful food options and more reasons to distrust the government and medical establishment.
That means they are more vulnerable to covid-19, which has shaved a staggering 2.7 years off the average life expectancy for Black Americans, compared with 0.8 years for White Americans.
Even within Prince George’s, White residents are getting vaccinated at far higher rates than Blacks or Latinos, despite being infected and dying at lower rates.
Rep. Anthony G. Brown (D-Md.), whose congressional district includes much of Prince George’s, said the emphasis on hesitancy could become a self-fulfilling prophecy that decreases willingness to take the vaccine among Black and Latino residents.
“You run the risk of not just creating a narrative,” he said, “but that you are shaping reality.”