One month into the COVID-19 vaccine rollout, Maine has used only about half of its 96,475 available doses, and it’s unclear how it will ever meet a goal of inoculating 50,000 people per week.

That’s the optimum weekly number health officials say is necessary to vaccinate 1.3 million Mainers by midsummer and possibly stave off another coronavirus surge next fall. But while logistical and staffing challenges threaten to hinder expanding Maine’s effort beyond the current rate of about 12,000 first doses per week, some health officials say they can’t effectively plan how they eventually might inoculate 50,000 people weekly because current vaccine shipments are so low and undependable.

State and national health experts have suggested that pharmacies could soon take a more prominent role in vaccinating the wider public, but pharmacies tasked with inoculating residents and employees at Maine’s long-term care facilities have yet to make a noteworthy dent in their vaccine allocation.

Maine health officials started hinting last week that they might organize mass vaccination clinics and set up a central online registry to begin signing up and scheduling eager would-be recipients, as New Jersey did last week. But Maine’s COVID-19 vaccination plan remains in “interim draft” form and most Mainers are still in the dark about where, when and how they will get their first dose amid a pandemic that has killed at least 432 people across the state.

Peggy Bell of Yarmouth, who has chronic asthma and is battling the effects of a brain tumor, has struggled to get straight answers from her primary care provider and her pharmacy.

“They said come back in March or April,” said Bell, 61. “We are just helpless when it comes to our health.”

Bell, a former business administrator, said she understands that current doses are designated for health care workers and long-term care residents and employees, which is about 130,000 people in Maine. As a person with high-risk medical conditions, she knows it’ll be awhile before it’s her turn.

But she also has heard Dr. Nirav Shah, head of the Maine Center for Disease Control and Prevention, say that it’s difficult to plan future phases of the vaccine rollout when current shipments are low and unreliable.

“That makes no sense to me,” Bell said. “We are so underprepared and we’ve had so much time to get ready. I try to be proactive with my health care. I don’t care if I get (the vaccine) in February or March or whenever. All I want to do is get on a list somewhere and I still can’t do that.”

Maine is doing better than most states, with an inoculation rate that’s been among the top 10 based on some measures. By Saturday, Maine had administered the first of two required doses to 47,656 people since the rollout began Dec. 15, according to the Maine CDC.

That’s 43 percent to 58 percent of the total doses that were allocated to Maine last month, depending on whether it’s the Maine CDC’s total of 81,850 doses ordered or the U.S. CDC’s total of 96,475 doses delivered. The national average was 32 percent, according to Bloomberg. An additional 4,668 second doses were given to health care workers in Maine last week.

Maine hospitals have been doing well in distributing the vaccine they receive, said Dr. James Jarvis, senior physician executive at Northern Light Health, a medical system that includes Mercy Hospital in Portland and Eastern Maine Medical Center in Bangor.

“Within a week of it arriving, we have used a tremendous portion of our vaccine,” Jarvis said.

Much of the COVID-19 vaccine supply that Maine hasn’t used is designated for long-term care facilities, Jarvis said.

During a Maine CDC media briefing Friday, Shah said about one-third of vaccine doses Maine has received are allocated to the retail pharmacy partnership that the federal government forged on behalf of nursing homes and assisted-living facilities with retail pharmacy giants CVS and Walgreens.

Shah said pharmacies had stepped up their efforts last week and that the number of vaccine doses administered at long-term care facilities in Maine was reflected in the 47,656 total of first doses. However, he was unable to provide that number during the briefing and didn’t follow through on an offer to provide that number afterward.

Lack of communication between the pharmacies and long-term care facilities has been a concern from the start, said Rick Erb, head of the Maine Health Care Association, which represents 92 nursing homes and 135 elder care assisted-living facilities across the state. There are more than 200 assisted-living facilities in Maine, including congregate housing for disabled adults.

“We’re a little bit in the dark,” Erb said. “It feels like we’re playing catch-up. No doubt there are complications in getting consent, scheduling and carrying out so many clinics at so many facilities. But we’ve heard from some assisted living facilities who haven’t been contacted by their pharmacy yet. There’s some frustration about that, not just for the residents, but for the staff as well.”

A Walgreens spokesman declined to provide data on the number of COVID-19 vaccine doses it has administered at long-term care facilities in Maine or nationwide. According to a statement on the chain’s website, Walgreens expects to complete first-dose delivery at skilled-nursing facilities it has partnered with by Jan. 25.

“(Walgreens) is also rapidly expanding access to vaccinations among assisted-living facilities and additional vulnerable populations outlined by states and local jurisdictions as part of expanded distribution plans,” the company’s statement said.

As of Friday, CVS had held vaccination clinics at 35 of 38 nursing homes in Maine that have partnered with the pharmacy chain, delivering 3,022 first doses to residents and staff members within the first three weeks of the vaccine rollout at skilled-nursing facilities, according to vaccination data on the company’s website that’s updated each weekday. The remaining three nursing homes were scheduled to hold first-dose clinics within the next seven days.

CVS also held vaccination clinics last week at 27 of 170 assisted-living center in Maine that have partnered with the chain, delivering 730 first doses to their residents and employees within the first week of the vaccine rollout among other long-term care facilities. As of Friday, CVS was scheduled to hold an additional 59 first-dose clinics at assisted-living centers within the next seven days, including one that was held Saturday at the Atria Senior Living community in Kennebunk.

In total, as of Friday, CVS had administered 561,569 first doses at long-term care facilities across the United States, accounting for a significant portion of the 7 million doses that Bloomberg tallied nationwide.

“Our work with long-term care facilities isn’t a mass vaccination effort, (but) quite the opposite,” said Larry J. Merlo, head of CVS Health. “We’re dealing with a vulnerable population that requires onsite and, in some cases, in-room visits at facilities with fewer than 100 residents on average. Despite these challenges, we remain on schedule, and the number of vaccines we administer will continue to rise as more facilities are activated by the states.”

Pharmacy teams will make three visits to each long-term care facility to ensure residents and staff receive their initial shot and critical booster. Most residents and staff will be fully vaccinated three to four weeks after the first visit, depending on whether they receive the Pfizer or Moderna vaccine, Merlo said.

But while long-term care residents and health care workers have been squarely identified and targeted to receive the first doses of COVID-19 vaccine, where, when and how other Mainers will get inoculated largely remains to be seen.

State health officials have repeatedly asked Mainers to be patient and suggested that primary care providers will contact their patients when it’s their turn to be vaccinated. But not every practice has signed onto that expectation, especially in a largely rural state that’s struggling to provide health care amid a global pandemic.

And many Mainers don’t have a primary care physician, including one man who’s a close friend of Peggy Bell. He has a variety of health problems. She’s worried about him, too.

“He doesn’t have a primary care provider,” Bell said. “Who’s going to call him?”

Some providers, such as InterMed, which has primary care and specialty practices in Portland, South Portland and Yarmouth, have begun notifying patients of their COVID-19 vaccination efforts.

InterMed sent an email to patients last week, explaining that it’s currently vaccinating health care workers and will expand to the next phase – people age 75 and older and front-line essential workers – when directed by the Maine CDC.

“We hope to be able to do this in early spring, but our timeline is dependent on vaccine supply at the federal and state levels,” the email stated. “Rest assured that there will eventually be a vaccine for everyone. We will contact you as we approach the phase appropriate for you, and ask that you please not call our office for updates.”

Other providers, including some practices affiliated with Central Maine Healthcare, told patients last week that they have no information about COVID-19 vaccine availability and referred patients to the Maine CDC website.

Health officials working on the state’s vaccine rollout acknowledge there’s room for improvement in communicating their efforts to the public, beyond telling people to be patient.

“I don’t think that’s serving the public’s confidence enough.” said Jarvis, of Northern Light Health. “They really want to see that list. And that’s what we’re trying to work on right now.”

Jarvis said Maine is trying to avoid problems that have cropped up in other mass vaccination efforts, such as Florida, where scheduling and logistical challenges resulted in people waiting for hours in long lines of cars.

“What we’re doing in Maine is trying to avoid that chaos,” Jarvis said. “At the same time, I think (the resulting delay) adds to people’s anxiety level because they want to know where they are on the list. And right now there is no list, but we need to create something that can work for us.”

Shah, with the Maine CDC, has suggested the need for a system that would allow Mainers to register in advance and schedule their vaccinations as soon as possible, similar to the website that New Jersey launched last week to preregister its residents.

Jarvis, who is a family practice physician, said the two-dose vaccines that are available now don’t lend themselves well to primary care practices. Small practices in particular may not have enough staff to dedicate to additional patient visits, enough space to maintain social distancing required under COVID-19 protocols or the ultra-cold freezers necessary to store the Pfizer vaccine.

Maine health and emergency management officials have begun discussing how and where mass vaccination clinics could be held, such as community centers, school gyms and other locations, and the online system that would be needed to register and schedule people in advance, according to Jarvis and Shah.

Hospital officials have learned that administering the COVID-19 vaccine is more time-consuming and labor-intensive than doling out flu shots; it takes as long as 45 minutes and several people to register, vaccinate and monitor each person afterward. Then each person must return three to four weeks later for a booster shot.

“The challenge is, you can’t just open up the doors and let people in,” said Dr. Dora Anne Mills, chief health improvement officer for MaineHealth, the system that includes Maine Medical Center in Portland. She’s also former head of the Maine CDC and Gov. Janet Mills’ sister.

Planning mass vaccination clinics presents a variety of logistical challenges, including the need to set up remote computer technology that can be operated by and interface with multiple users, Dr. Mills said.

Staffing the clinics also presents some hurdles because registrars, vaccinators and observers must be checked for qualifications and undergo special training, whether they are paid staff or volunteers, Mills said. The MaineHealth and Central Maine Healthcare systems have relied heavily on volunteers to vaccinate their employees, and volunteers are expected to play a significant role in vaccinating the wider public.

Mills and Jarvis agree that it will take multiple partners and a communitywide effort to vaccinate all Mainers against COVID-19. That will include continuing efforts by hospitals, pharmacies, public health and emergency management agencies, home health providers, employers and others.

“It’s going to take partnerships, for sure, and larger clinics with high through-put,” Mills said. “We need to pick up the pace and we’re working hard to do that. There’s been a lot of work going on behind the scenes. But we’re in the middle of a big surge (in COVID-19 cases), and it’s hard to see all the deaths and know we can’t get vaccine into arms fast enough.”

Jarvis said he’d like to have everyone in Maine vaccinated by midsummer. He knows it’s a tall order. He calls it “the World War II of our generation.” And he admits Maine is off to a slow start.

“We’re clearly behind where we would like to be right now,” Jarvis said. “But if we get to a point where we can have 10,000 doses a day delivered into people’s arms, that’s where we need to be.”

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