These stickers are given out to people who receive the COVID-19 vaccine at Penobscot Valley Health Center in Bangor. Credit: Linda Coan O'Kresik / BDN

Maine will introduce a new set of performance measures to scrutinize COVID-19 vaccine providers more closely when it comes to how quickly they are giving shots in a move that could change where doses are sent across the state.

The state has not yet determined the set of metrics, a Maine Department of Health and Human Services spokesperson said, but a Tuesday memo to providers indicated they will be used to help clinics improve performance or lead the state to send vaccines elsewhere.

It was welcome news to representatives of pharmacies, hospitals and independent physicians, who were confident any new metrics would demonstrate their capability to handle more doses. Experts said while gauging the speed at which providers are giving shots is valuable, the state should also consider the amount of time it takes for people to be vaccinated and equity factors.

“Our hospitals are ready, willing and able to do a lot more than we have now,” said Steven Michaud, president of the Maine Hospital Association. “The more we get, the more we can administer.”

Short national supply also hangs over the entire distribution effort. While all groups distributing vaccines are clamoring for more doses, it is unlikely everyone who performs well will see an immediate groundswell in vaccines due to these changes.

In Maine, two hospitals have been criticized by the state for how they distributed some vaccines. MaineHealth — the biggest health care system in the state — was hit by Gov. Janet Mills for vaccinating consultants and non-patient-facing employees, while MaineGeneral Health in Augusta offered vaccines to a small group of older donors as part of a trial clinic.

For now, Mainers over 70, people with conditions making them vulnerable to the virus plus long-term care facility residents and employees, health care workers and first responders are eligible for vaccines. Attorney General Aaron Frey’s office warned providers on Tuesday that misusing doses could result in them being taken away. The new state guidelines to providers foreshadowing the performance metrics was issued just before that warning.

Maine also faces equity questions. High non-response rates have made it difficult to ascertain how many people of color are getting the vaccine here. Some have had to drive hours. Distribution has cut counterintuitively across the state, with Aroostook County pacing the state by share of population vaccinated before being overtaken by Sagadahoc and Cumberland.

State officials have said no doses have been wasted. But they released a policy on Tuesday indicating sites may use leftover doses to vaccinate eligible Mainers on waiting lists, people between the ages of 65 and 69 and vaccine clinic staff, with the oldest ones prioritized first.

There are even different metrics to consider when evaluating a state’s success in distributing vaccines. Maine has administered 78.6 percent of its total received doses, ranking it about middle of the pack nationally, according to Bloomberg News. But at least 13.2 percent of its population has received at least one dose, with only five states immunizing more.

Maine Center for Disease Control and Prevention Director Nirav Shah cautioned reporters on Tuesday from relying on one metric, saying he thought there was a discrepancy in how the state and the federal CDCs were reporting data.

“What we’re seeing for the most part is doses are coming into the state, we are getting them to providers who are getting them into arms by the thousands per day,” he said.

The state has also moved doses if it does not think vaccines are moving fast enough. It took thousands of vaccines from Walgreens and CVS Health, the chains vaccinating in long-term care facilities under a federal program, and sent them to independent pharmacies. Last week, it sent no doses to the chains because it determined they had enough doses.

Joe Bruno, CEO of Augusta-based Community Pharmacies, said his employees have demonstrated their ability to get vaccines out quickly, oftentimes pulling 12 doses out of one vial and vaccinating hundreds per day. His company has been part of state efforts to vaccinate long-term care facilities and Mainers over 70.

“We don’t have any laying around like the big-box stores do,” he said.

But Dan Morin, a spokesperson for the Maine Medical Association, said he hoped the new metrics would encourage the state to send doses to independent providers who have been left out of the vaccination program so far. Shah has said the state prioritizes distribution based on which providers have a demonstrated ability to deliver a high amount of shots.

Morin said his group has been working with the state to develop a consortium model allowing those providers to partner with bigger organizations, an effort the state says will help distribute vaccines in rural areas.

“We couldn’t be happier that the state has implemented more accountability,” he said.

Shots are not the only metric the state should watch, said John Gale, a health care researcher at the University of Southern Maine and the president of the National Rural Health Association. It should monitor how long it takes people to get shots from the time they are eligible and how many doses providers have left daily, he said. They would demonstrate how effective a provider is, but they would also illuminate access issues such as if travel or weather.

Maine should also watch to see if a racial demographic appears to be getting a disproportionate amount of vaccines and track daily changes in the number of vaccines distributed, said Jennifer Nuzzo, an associate professor at the John Hopkins Bloomberg School of Public Health.

She pointed to people over 70 getting vaccinated as an example. A slowdown in that population could mean travel challenges requiring the state to open clinics in rural areas, she said. Or “maybe the rest doesn’t want it,” indicating the state has reached saturation for one population and it is time to open vaccines to another group.