End of Maryland nonprofit’s state health contract leads to rocky vaccine rollout in some counties

Back-to-school vaccine clinics got off to a rocky start in some Maryland counties this year after the state health department did not renew a statewide contract with a Baltimore-based nonprofit that supports such immunization efforts.

Without the help of nurses from the Maryland Partnership for Prevention or PrepMod, the nonprofit’s scheduling and vaccine documentation software, at least three county public school systems did not hold their usual flu vaccination clinics. The end of the contract disrupted routine vaccine distribution in at least two other counties, officials said.

The Maryland Department of Health had contracted with the nonprofit since fall 2020 to allow Marylanders to use PrepMod to schedule appointments at COVID-19 vaccination sites around the state. Health care providers used PrepMod to report immunization data to the state health department, and some county schools used the software to allow parents to register their children for school vaccination clinics.

The state paid the nonprofit about $5 million for the three years the contract was in effect, said Tiffany Tate, the organization’s executive director. It covered nursing services and the statewide use of the PrepMod software for more than 14,000 health care providers, she said.

With the end of the contract, it’s likely fewer school-aged children will be vaccinated this year in Carroll County, said Carey Gaddis, a spokeswoman for the school system, said in an email. The school system had worked with the Maryland Partnership for Prevention for about six years to deliver vaccines at school, she said, and in the three years leading up to the coronavirus pandemic, about 4,500 students were vaccinated at school-based flu clinics.

School officials, however, are hopeful the effects of the contract ending will be lessened because of the local health department’s increased immunization efforts, Gaddis said. The department held two flu vaccination clinics last month for children 6 months through 18 years and is planning another one this month.

The Carroll County Health Department also notified local pediatricians and family doctors to let them know, so they’d be prepared to vaccinate more patients, said Maggie Kunz, a department spokeswoman, in a statement

School systems in Harford and St. Mary’s counties also aren’t holding school-based flu clinics this fall due to the contract ending, officials said. Instead, both counties are offering walk-in clinics and hope to reach a similar number of children as they have in the past.

Elizabeth Kromm, director of the Maryland Department of Health’s Prevention and Health Promotion Administration, acknowledged in an interview that the department has heard about some “hiccups” in patient registration and getting immunization efforts up and running this year.

However, she said, the department’s contract with the Maryland Partnership for Prevention was focused on mass vaccination efforts during the pandemic. Its support of flu and childhood vaccinations was a “nice added benefit,” she said, but not the contract’s purpose.

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The health department decided not to extend the contract this year — after extending it for two years — following the end of the public health emergency. State officials worked with local health departments to return to how they delivered immunizations before the pandemic, Kromm said.

Besides, she said, the state health department doesn’t have a contracting relationship with county school systems. Local health departments and schools boards are free to make their own contracting decisions, she said.

“This is our first fall without the public health emergency,” Kromm said. Maryland is “transitioning back to what life was like before the pandemic, with some modifications. I’m not surprised that there were bumps along the way.”

The state health department also made about $4.8 million available to local health departments to support their vaccination efforts — about 10 times what it provided for back-to-school vaccinations last fiscal year, department spokesman Chase Cook said in an email.

“We strongly encourage families to continue reaching out to their local health departments, pharmacies and health care providers to find flu clinics,” Cook said in his statement. “Flu shots are abundant and available.”

The Maryland Partnership for Prevention started in 1999 to bolster vaccination efforts among African American seniors in Baltimore and began helping counties deliver vaccines in schools and at community clinics in 2015.

Tate, the nonprofit’s executive director, said she was surprised when she learned the state contract wouldn’t be extended. She said it was her understanding that it would be funded through the end of fiscal year 2025.

She worries that fewer Maryland children will be vaccinated this year. Since the start of the contract in 2020, Tate said, the nonprofit has supported nearly 1,500 vaccination clinics in nearly every Maryland county.

Without the state contract, school systems needed to individually contract with vaccine providers — a process the Carroll County school system doesn’t have the staffing to accomplish, Gaddis said.

The decision not to extend the nonprofit’s contract surprised Claire Hannan, executive director of the Association of Immunization Managers, a national nonprofit that advocates for vaccination education and accessibility. She called PrepMod “groundbreaking” and said it has become part of the Maryland public health infrastructure.

“It’s disappointing to see that counties would not be able to sustain their school vaccination clinics because of a move away from PrepMod,” she said.

Other counties reported mixed results after losing PrepMod.

Dr. Miriam Dobson, director of the Frederick County Health Department’s Community Health Services Division, called the transition “smooth.” The department used PrepMod during the pandemic, but now uses its electronic health records system.

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But Prince George’s County Public Schools couldn’t schedule appointments for its back-to-school vaccination clinics and had to operate on a first-come, first-served basis, said Lynn McCawley, a school system spokeswoman. This led to longer lines, and officials had to limit each clinic to 100 students.

The Prince George’s school system hired the Maryland Partnership for Prevention as a consultant last month, which will allow the system to return to appointment-based clinics.

Howard County Public Schools obtained an emergency contract to continue working with the nonprofit, Tate said.

Kerrie Wagaman, director of health services for the Howard school system, said that without the help of extra nurses from the nonprofit, the school system wouldn’t have been able to hold school-based vaccination clinics and fewer children would get vaccinated.

As of last week, Howard schools had administered 4,581 student flu shots and 3,139 student COVID shots with the help of the nonprofit staffing and PrepMod.

“I barely have a nurse in every building,” Wagaman said. “In order to be able to cover a health room adequately for sick and injured [students] and students getting medications and treatments, I wouldn’t have the staff to go to a school to administer vaccines as well.”

So far this year, about 17% of Marylanders have gotten flu shots, according to state health data. Last flu season, about 37% of state residents were vaccinated. As of Monday, one person had died from the flu this season and 31 people had been hospitalized.