Claire McDonough, pharmacy operations manager at Central Maine Healthcare, opens a box of Moderna COVID-19 coronavirus vaccines in Lewiston, Maine on Monday, Dec. 21, 2020, after receiving 600 doses at the Central Maine Medical Center. Credit: Ann Kim / Central Maine Medical Center via AP

Just over a quarter of long-term care facilities surveyed recently in Maine said less than half of staffers are willing to get the coronavirus vaccine, a trend that could hamper efforts to prevent deadly outbreaks as vulnerable residents overwhelmingly accept the shots.

The Maine Medical Directors Association, which represents nursing home directors, surveyed 63 skilled nursing homes, assisted living facilities and other places in the first phase of Maine’s vaccine program over a 10-day period ending Tuesday. It provides the first data showing how efforts to inoculate some of the state’s most vulnerable people are going.

About 27 percent of homes surveyed said less than half of their staff had agreed to be vaccinated. The other three-quarters reported between 50 percent and 99 percent of staff were willing to be vaccinated. At the same time, 97 percent of facilities saw over half of residents agree to be vaccinated, with 17 percent saying every resident agreed to be vaccinated.

It is a stark difference in Maine, which is the nation’s oldest state by median age and has long-term care facilities that have had the worst outbreaks of COVID-19. Their residents constitute 57 percent of the deaths from the virus in the state but only 10 percent of total cases, according to the Kaiser Family Foundation. That is the eighth-highest mark among states.

While vaccine hesitancy has diminished nationally, one in six people in a December survey of employees at Yale Medicine and Yale New Haven Health system said they were wary of getting the vaccine in the first wave. A top federal health official indicated concern about opt-out rates among health care workers in a briefing earlier this month.

“You’re not protecting residents if you’re not getting the workers vaccinated as well,” said Edward Miller, a professor who studies aging and long-term care at the University of Massachusetts Boston.

Hesitancy factors are varied and complex, including anything from being pregnant at the time, fearing an allergic reaction or being skeptical of the vaccines’ emergency approval timeline, although the vaccine is proven to be safe. Complicating matters, long-term care workers tend to be lower-income and people of color, Miller said, populations more likely to contract COVID-19.

Vaccinations in long-term care facilities are largely taking place through a federal partnership with Walgreens and CVS Health, although Maine officials have signaled they are increasingly willing to divert doses to independent pharmacies to speed distribution. Demand for vaccines has been high among a large population of older Mainers, but federal supply has been a challenge to that effort and outbreaks at facilities have continued despite restricting visitations.

The U.S. Equal Employment Opportunity Commission has indicated employers may be allowed to require the vaccine for people to work, with some exceptions. But health care providers in Maine are not requiring the vaccine now. Miller said employers could also explore ways to incentivize workers, such as bonuses or time off to get vaccinated.

Education is the way to go and workers may be more willing to get vaccinated after they see their peers undergo the process, said Dr. Jabbar Fazeli, a spokesperson for the Maine Medical Directors Association. Vaccine acceptance among staff at Durgin Pines, a Kittery retirement community where Fazeli is medical director, jumped from 50 percent to 70 percent after the second round of vaccines. He is hoping it will be closer to 100 percent by the third clinic, scheduled in three weeks.

“It just goes to show that getting the vaccine [doses] is only half the battle,” Fazeli said.

Fazeli said he was concerned that some facilities had not yet had their first clinics, saying he had believed the program would move quicker. He pointed to challenges like scheduling and vaccine supply as possible reasons. Maine had to put off some vaccinations in long-term care facilities after receiving fewer doses than expected, although it has cleared all nursing homes.

The Maine Center for Disease Control and Prevention has taken nearly 3,000 doses from Walgreens and redistributed them when it learned the chain had no plan to immediately use them. Robert Long, a spokesperson for the Maine CDC, said the state will take another 500 doses next week — this time from CVS Health — for the same reason.

Some facilities have found vaccination efforts have gone quicker with independent pharmacies. Nancy Cole-Daigle, the administrator of Madawaska-based High View Rehab & Nursing Center, said the center was supposed to get its vaccines from a CVS affiliate before Christmas.

The vaccines never showed up, so Cole-Daigle reached out to St. John Valley Pharmacy in Fort Kent, which partnered with Northern Maine Medical Center to start the center’s vaccinations on Dec. 30. Since then, 92 percent of residents and 60 percent of workers have opted in.

High View was one of four Aroostook County nursing homes hit with outbreaks in late December. Some affiliated staff are still recovering. Cole-Daigle hopes that when they are better, they will consider getting vaccinated for their families and the patients they work with.

“I’m hoping this will put nursing homes back on the mend,” she said. “Some residents haven’t seen their loved ones in some time.”

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