During the early weeks of Maryland’s vaccination program, vaccine supply is expected to be limited. With a limited supply of vaccines, healthcare workers, first responders, LTCF residents and people at significantly higher risk of severe COVID-19 disease will need to be sub-prioritized. Multiple factors, informed by the National Academies of Science, Engineering and Medicine’s Framework for Equitable Allocation of Vaccine, have been considered for sub-prioritization, such as, but not limited to:

Risk of acquiring infection: People have higher priority if work or live in an environment with a higher risk of transmission due to a circulating virus.
Risk of severe morbidity and mortality: People with a high risk of severe outcomes (hospitalization, mechanical ventilation) and death from SARS-COV-2 infection. People who are older or have chronic medical conditions are at higher risk of severe outcomes.
Risk of negative societal impact: Inability to maintain services to preserve the functioning of society (i.e. providing health care, emergency response, public safety).
Risk of transmitting the virus to others (at work or at home): People have higher priority if there is a higher likelihood of them transmitting the disease to others.

In the setting of limited vaccine supply, BCHD is utilizing ethical principles as outlined by ACIP to guide sub-prioritization decision making. These ethical principles are:

Maximize benefits and minimize harm: Allocation of vaccine to groups or individuals should maximize the benefits of vaccination – reduction in hospitalization and death and reduction in risk of SARS-COV-2 infection, the virus that causes COVID-19. Preserving the functioning of society and minimizing harm to certain individuals and groups should also be considered.
Promotion of justice: All individuals and groups should have equal opportunity to receive the COVID-19 vaccine, within priority populations during constrained supply and when the vaccine becomes available to the general population.
Mitigation of health inequity: Certain groups have been disproportionately impacted by COVID-19 with an increased risk of infection, hospitalization, and death. Socioeconomic marginalization, age distribution, occupation/employment-type, limited access to healthcare are intersecting determinants of health that have resulted in disparate outcomes in hospitalization and death among older adult, Latino/Hispanic, and African American Baltimore City residents. Prioritization of vaccine allocation for certain groups should aim to reduce health disparities and not widen or create disparities.

BCHD’s sub-prioritization decision making is grounded in the promotion of transparency. Transparency is essential to building and maintaining community trust. Outreach to priority groups throughout the vaccination program is critical. BCHD is engaging community members, collaborating with City government agencies, local health organizations, and health systems to inform focused outreach to priority groups. BCHD is developing a public-facing COVID-19 vaccination data dashboard to show vaccine administration by age, race/ethnicity, neighborhood, and other demographics, and to help inform outreach to priority groups

Priority Groups and Tiers

The following is the sub-prioritization for allocating the COVID-19 vaccine in Priority Group 1A, Priority Group 1B, and Priority Group 1C. Settings and roles within a priority group have equal priority. Vaccine allocation within Priority Groups is tiered due to initial limited vaccine supply. List order does not imply ranking within a tier. Sub-prioritization was developed in concert with Health Officers from Maryland jurisdictions for near consistent prioritization across the State. Baltimore City Health Department is taking into account specific population factors and priorities to tailor sub-prioritization to meet the needs of Baltimore City.

Priority Group 1A

Tier 1

Hospital-based healthcare workers
Long-Term Care Facilities staff and residents
Acute Living Facilities (ALF) staff and residents

Hospital systems are responsible for vaccine administration to hospital-based healthcare workers. The CDC's Pharmacy Partnership is coordinating the distribution and administration of vaccination in congregant living facilities, and both CVS and Walgreens have partnered with CDC to distribute and administer vaccines to LTCF staff and residents.

BCHD is responsible for vaccinating first responders and some healthcare workers in this tier. BCHD received 100 doses of Moderna vaccine the week of December 20th and received an additional 2600 doses the week of December 27th. BCHD began vaccinating public health vaccinators, COVID-19 testing staff, and clinical services staff on December 29th. The Health Department is prepared to respond to anaphylaxis/severe allergic reactions after the COVID-19 vaccination and is pre-screening individuals to determine if there are any contraindications or precautions.

Tier 2

Definition: Populations with frequent exposure to individuals with known COVID-19 and/or providing services essential to the maintenance of public health and healthcare systems during the COVID-19 pandemic. Includes populations unable to work from home and unable to control social distancing.

Public Health vaccinators and those administering COVID-19 vaccine in Phase 1A.
Emergency Medical Services/Fire Department
COVID-19 testing staff: People providing testing at large community testing centers
Lord Baltimore TRI Center staff
Convention Center Field Hospital staff
Baltimore City Health Department Clinical Services and Syringe program staff
Urgent Care Staff
Dialysis Center Staff
Clinic-based primary care staff (internists, family practice, pediatricians, geriatricians)/Federally Qualified Health Centers
Home health staff
Correctional facilities/Detention Center health care staff
Public Health/Baltimore City Health Department Staff

Tier 3a

Definition: Populations with risk of exposure to individuals with suspected COVID-19 and/or providing services essential to the maintenance of public health and health care systems during the COVID-19 pandemic. Includes populations unable to work from home and unable to control social distancing.

Law Enforcement: Police Department
Law Enforcement: Correctional facility officers, Sheriff’s Office, Department of Public Works Police
Dentists
Pharmacists
Phlebotomists

Tier 3b

Definition: Populations at risk of exposure to individuals with suspected COVID-19 and/or providing services essential to the maintenance of public health and health care systems during the COVID-19 pandemic. These populations may be able to telework or control social distancing.

Community Health Workers
Home and Community- based visiting program staff
Specialty out-patient clinical staff
Outpatient surgery centers
Student Health staff at non-hospital affiliated academic institutions
Laboratory staff
Physical Therapy/Occupational Therapy
Chiropractors
Optometrists
Audiologists
Podiatrists
Behavioral Health
Nutritionists
Morticians

Priority Group 1B:

Tier 1

Definition: It is well established that certain groups are at significantly higher risk for severe COVID-19 illness. Older adults ≥ 75 years old have a >30 times higher risk of death from COVID-19 compared to persons 35-54 years old.

Adults ≥ age 75 years

Tier 2a

Definition: Other attributes that put people at significantly higher risk for severe COVID-19 illness include living and working in congregate settings, experiencing homelessness, living in an area with a high rate of transmission, and working in an industry with a high rate of transmission.

People experiencing homelessness
Shelter staff and residents
Correctional Facilities/Detention Center inmates and staff
Individuals in group home settings (i.e. halfway homes for returning citizens)

Tier 2b

Definition: Front-line essential workers hold critical jobs essential to the functioning of society and have potential occupational exposure to individuals with COVID-19. A subset of frontline essential workers has the highest risk for potential exposure as they are unable to work from home or control social distancing.

Public and private transit workers
Education sector (Teachers and support staff in schools)
Child care workers
Food and agricultural workers (Restaurant workers, Food Pantries, Farmers Markets, Farms)
Postal service workers
Grocery/Convenience store workers

Tier 3

Manufacturing workers

Priority Group 1C:

Tier 1

Definition: It is well established that older adults are at significantly higher risk for severe COVID-19 illness. More than 40% of COVID-19 hospitalizations were in adults aged 65 years and older.

Adults 65 – 74 years old

Tier 2

Definition: Populations with high-risk medical conditions have a significantly increased risk of hospitalization and death from COVID-19. Nearly 90% of persons hospitalized for COVID-19 have an underlying medical condition.

Adults 16/18* – 64 years old with high-risk medical conditions. High-risk medical conditions include:
- Cancer
- Chronic Kidney Disease
- Chronic Obstructive Pulmonary Disease
- Heart conditions
- Immunocompromised state
- Obesity/Severe obesity
- Pregnancy
- Sickle Cell Disease
- Smoking
- Type 2 Diabetes, Type 1 Diabetes
- Asthma (moderate-severe)
- Cerebrovascular disease
- Cystic fibrosis
- Hypertension or High Blood pressure
- Immunocompromised conditions (from blood or bone marrow transplant, immune deficiencies, HIV, prolonged use of corticosteroids or other immunosuppressive medication)
- Dementia, ALS, other neurologic issues
- Liver disease
- Pulmonary disease
- Thalassemia

*Individuals 16 years and older can receive the Pfizer COVID-19 vaccine under the FDA EUA. Individuals 18 years and older can receive the Moderna COVID-19 vaccine under the FDA EUA.

Tier 3

People experiencing homelessness
Shelter staff and residents
Correctional Facilities/Detention Center inmates and staff
Individuals in group home settings (i.e. halfway homes for returning citizens)
Essential workers not previously in Phase 1A or Phase 1B
Transportation & logistics
Water and wastewater
Foodservice industry
Shelter & housing (e.g. construction)
Finance (e.g. banks)
IT & Communications
Energy
Legal (state’s attorneys, public defenders, judiciary)
Media
Public Safety (e.g., engineers)
Social & Human Services (Aging, DSS, Human Services) – field/in-home services
Elected officials

Priority Groups 2 and 3

In the future, individuals who would like to receive the COVID-19 vaccine will be able to pre-register to express their interest. This will help us plan our local vaccination clinics and help us share information about upcoming clinics for those who choose to sign-up.
We are also making plans to account for those who are unable to pre-register and would still like to receive the vaccine. We know that many people in Baltimore City don’t have the internet at home and may have challenges pre-registering online.
Once plans for Priority Groups 2 and 3 have been finalized, we will update this webpage!

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