York County is facing a glaring disconnect between coronavirus infection rates and the percent of people vaccinated against COVID-19, despite the county’s standing as a hotspot throughout the nearly yearlong pandemic.

Officials say they are working to close that gap by opening a mass vaccination site by month’s end and directing additional vaccine doses to Maine’s second most-populous county.

Since the coronavirus was first detected in Maine 11 months ago, York County has accounted for 21 percent of the state’s COVID-19 cases but just 11 percent of vaccine doses administered as of Friday. While only Cumberland and Penobscot counties have higher percentages, the rate of doses flowing into York County is among the lowest in the state on a population basis.

Exactly 9 percent of York County residents had received at least one dose of vaccine compared to 12 percent statewide and more than 14 percent in neighboring Cumberland and Sagadahoc counties, according to data posted on Friday by the Maine Center for Disease Control and Prevention.

Crunching the numbers on a per capita basis, York County has administered 12 doses for every 100 residents – a lower rate than all but three of Maine’s 16 counties and well below the statewide average of 17 doses for every 100 Mainers. Cumberland County, by contrast, has administered 20 doses for every 100 residents while 19 shots have been administered for every 100 residents of Aroostook.

Those discrepancies, combined with difficulties signing up for vaccination appointments, have frustrated many York County residents eligible for vaccines and left some local officials puzzled.

“York County has been the epicenter of the pandemic,” said Rep. Michele Meyer, D-Eliot, a retired nurse who co-chairs the Legislature’s Health and Human Services Committee. “We are densely populated and there is a great demand here in our far southern coastal corner of the state where we have many seniors who are currently eligible. … Even with the inadequate supply coming into the state, the supply coming to our region has been woefully inadequate.”

The potential reasons for those discrepancies are numerous.

York County has been slower to launch vaccination clinics than other counties and, as a result, has received fewer vaccine doses. The county’s population skews slightly younger than counties such as Aroostook, Lincoln and Knox, where larger percentages of residents age 70 or older mean more people are eligible for vaccines.

The southernmost communities in York County also share closer economic and workforce ties with areas south of the state border than with towns farther north along Interstate 95. Additionally, York County lacks a centralized service center community like Portland, Bangor or Lewiston.

“York County is a very decentralized county,” said Sen. Mark Lawrence, D-Eliot. “Down here, we are connected to a metropolitan area that extends through New Hampshire to Massachusetts and we’re not connected to the Portland area. … So it’s not like in Cumberland County, where you can put a (vaccination) site in Portland and that is a centralized location.”

FEWER OPTIONS

There are only two vaccination clinics currently operating in York County – one at Southern Maine Health Care’s hospital in Biddeford and another at York Hospital.

By contrast, Cumberland and Penobscot counties each have eight clinics administering vaccines, Washington and Aroostook counties have five each, and there are four clinics in both Kennebec and Hancock counties.

It’s unclear why York County’s older residents have fewer options than their counterparts elsewhere, although it sometimes appears to be a “chicken-or-the-egg” situation. While local officials have said they need promises of consistent vaccine supplies to stand up clinics – and dose supplies were notoriously inconsistent nationwide before last month – state officials are only sending doses to places that can quickly inject them into the arms of eligible individuals.

“I’m not going to send doses to places where they can’t be administered,” Dr. Nirav Shah, director of the Maine CDC, said recently when asked about allocations to York County. “I’ve got to make sure that there is capacity on the ground to administer those doses, otherwise sending a bunch of doses to somewhere doesn’t help anybody with anything.”

But Shah added: “We fully recognize that there needs to be both more vaccine as well as more opportunities for vaccination within York County. Hopefully, in the coming days and coming weeks, we’ll be able to get that … in better shape.”

York County residents have gained access to additional vaccines since those early-February comments thanks, in large part, to larger allocations to the Biddeford hospital and the launch of a vaccination clinic at York Hospital.

The biggest shift is expected to happen by the end of February, however, when a mass-vaccination clinic opens in Sanford.

A contract was recently finalized to open the high-volume clinic at the former Marshalls store located at The Center for Shopping retail complex on Main Street in Sanford. While the pace of vaccinations will depend on dose supplies, the clinic is being set up to administer up to 1,000 shots a day.

“Once the vaccinations start coming in in quantities, and of course that’s the big void, … we will have a large-volume center,” said Art Cleaves, director of the York County Emergency Management Agency.

Cleaves said the clinic will be a partnership between his agency, Southern Maine Health Care and area fire/rescue departments that will provide EMTs and firefighters to help staff the facility. Cleaves said the groups began working closely with each other on a joint clinic several weeks ago, after realizing there were parallel initiatives underway that would likely happen faster together.

Robert Long, spokesman for the Maine CDC, said the agency’s public health district liaison for York County has “worked extensively with local and county officials to overcome logistical challenges for the clinic” while others have shared expertise on cold storage, infection control, transportation and other issues. Another staffer is working full time on high-volume vaccination clinics around the state.

“As the Sanford site moves closer to opening, we continue to explore other ways to quickly and fairly vaccinate at-risk York County residents and other at-risk Maine people,” Long said. “But this is all happening within the context of a highly constrained vaccine supply. Sites like the ones in Sanford, at Scarborough Downs, and at the Cross Center in Bangor demonstrate that we have the framework to increase our vaccination rate significantly as soon as our federal partners can deliver more doses to Maine.”

‘GETTING INTO THE GROOVE NOW’

Southern Maine Health Care received 1,000 doses of vaccine last week and 800 doses the week before. York Hospital, meanwhile, has received 800 doses for each of the past two weeks.

After a rocky rollout of its vaccination sign-up two weeks ago, York Hospital successfully launched a pre-registration system last week and was averaging about 170 shots administered per day. The hospital moved its vaccination clinic into a larger space at St. Christopher’s Church in York with a goal of eventually delivering up to 500 shots a day once supplies allow, said Erich Fogg, director of walk-in services and one of the leaders of York Hospital’s COVID-19 vaccination program.

Fogg said he was unsure why the pace of vaccinations has been slower in York County but said the lack of a statewide registration and appointment system led to a “disparate and kind of fragmented” rollout as hospitals scrambled to launch their own systems. Southern York County also lacks a large venue such as Scarborough Downs or Bangor’s Cross Insurance Center, where MaineHealth and Northern Light Health have recently launched mass-vaccination clinics.

But Fogg said York Hospital’s vaccination program is “getting into the groove now” and is hoping for a steady supply of doses moving forward after 800-dose shipments in each of the past two weeks.

“If I knew I had thousands of doses of vaccine through the spring, we could have set up a clinic with some longevity to it that would not have had the challenges that we saw last week,” Fogg said in reference to the confusion and frustration during the hospital’s initial signup. “But it’s complicated.”

Smaller-scale efforts are also underway to bring vaccine doses into rural York County.

The Southern Maine Agency on Aging has partnered with Northern Light Health to hold clinics in Limington on Friday and Cornish on Saturday for individuals in the 70-plus age group. Megan Walton, CEO of the Southern Maine Agency on Aging, said the organization will continue to work with Northern Light Health to target new locations based on the calls her agency is receiving from older Mainers.

Additionally, the agency is training more volunteers to help older Mainers navigate the confusing vaccine registration and appointment systems and also try to connect individuals with transportation to vaccination clinics. The agency also plans to include information on vaccine resources with food delivered to more than 1,000 Meals on Wheels recipients.

“We want to make sure we are doing our part in addressing the tremendous need in our population right now,” Walton said.

WAITING IMPATIENTLY

Rep. John Tuttle, a Sanford Democrat and an EMT for more than 40 years, has been hearing from local residents in their 80s who don’t have the computer skills or access to sign up online. Tuttle, who is also a member of the Sanford City Council, has been pushing to locate the high-volume clinic in his city but remains skeptical about supplies of doses given the inconsistency since December.

“Hopefully we can get something going,” Tuttle said. “We are the second largest county in Maine and we are way far behind as far as inoculations.”

Hazen Carpenter, 88, of Springvale is among those waiting impatiently for a chance to get his shot, along with his 87-year-old wife, Connie.

The retired business owner said he and his wife registered with MaineHealth weeks ago but have yet to hear back about an appointment. A veteran, Carpenter said he was offered a chance to get a shot himself through the Togus VA Medical Center in Augusta but said he won’t do that unless his wife can be vaccinated at the same time.

Carpenter said it is frustrating to see acquaintances in their 60s and 70s receiving vaccines, often in other states, while he and other Mainers in their 80s wait for appointments. Federal vaccine distributions have, so far, been based strictly on state populations. But Carpenter argued that, based on the state and federal prioritization of older individuals, Maine should receive a larger share as the state with the highest concentration of people over age 65.

But he isn’t necessarily surprised that York County has lower inoculation rates.

“It seems to be me that we are always on the tail end of things,” Carpenter said. “We are the gateway to the state of Maine. … People come through here all of the time, and not only do they bring money to the state but now they bring the virus. And now we are way behind.”

LAWMAKERS WATCHING

In addition to working with York County officials on the Sanford clinic site, Maine CDC officials have said that they hope the mass-vaccination clinic at Scarborough Downs will help address some of the demand in York County. Located in the enclosed grandstand of the former harness racing track, the MaineHealth-operated clinic could eventually handle up to 2,000 people a day if supplies allow.

State lawmakers from York County are closely monitoring the vaccine distribution and administration trends.

Meyer, the Eliot Democrat who co-chairs the Health and Human Services Committee, said members of the local delegation meet virtually with county leaders as well as hospital officials to hear about any concerns and offer other assistance. She said the delegation will continue advocating for additional doses for York County.

While the Sanford clinic will help, that is still 30 miles from residents in her area, some of whom have no access to transportation. So Meyer said she will also continue to push to ensure doses to go York Hospital and any other small, local clinics.

Lawrence, who represents Maine’s southernmost Senate district, said he hopes that York County’s numbers will “tighten up” relative to other areas as the vaccine phases allow people under age 65 to be inoculated. And he believes the Sanford site will help.

“They are kind of looking at it as a spoke-and-wheel situation where they are going to have the Marshalls site but they are also going to have the spokes going out into more rural areas,” Lawrence said. “So they recognize the situation. It’s just a matter of time, getting it set up.”

Meanwhile, House Speaker Ryan Fecteau, D-Biddeford, said some of the registration and scheduling challenges that older Mainers reported in recent weeks appear to be improving. Fecteau said while he’d “love to see this happening a lot more quickly,” standing up new vaccination clinics at a time of severely limited vaccine supplies has been the major challenge faced by the Mills administration, the Maine CDC and partners.

Fecteau, who at age 28 predicts his vaccination is still likely months away, saw parallels between the current crush for vaccine appointments and COVID-19 testing earlier in the pandemic.

Over the summer, it took time to stand up testing sites and to help people navigate the process of finding the location and making appointments. But there are now testing locations throughout the state, and the process has become streamlined.

“I haven’t heard from constituents in many, many months that have said they haven’t been able to get a test,” Fecteau said. “And I think the situation with the vaccine will be the same.”

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