Anne and Armand Bouchard of Harpswell are in their 80s and both have Type II diabetes. They wonder when they might get COVID-19 vaccinations. Brianna Soukup/Staff Photographer

People around Maine are wondering when they might have the chance to get vaccinated, now that the state is in the early stages of coronavirus vaccine distribution with front-line health care workers receiving the first shots.

Health officials have said it could be months before the vaccine is available to everyone who wants it. With initial supplies limited, high-risk health care workers are getting it first, along with residents and employees of nursing homes and long-term care facilities.

State officials and health care providers are grappling with who comes next, how those people will be identified and contacted, and how to ensure equitable access to the vaccine.

For now, there may be more questions than answers. The future of vaccine distribution depends on how much becomes available, whether additional vaccines gain federal approval, and how quickly health care workers and nursing homes get vaccines.

“I know they have to take care of essential people first, but once that’s done, the question on our minds is how will they know the age we are and the Type 2 diabetes we have and how to put us on the list?” said Armand Bouchard, an 82-year-old Harpswell resident. He and his wife, Anne, have Type 2 diabetes and are eager to get the vaccine.

“We are both ready and willing,” Bouchard said. “If you call me this afternoon, I’ll go down and get it.”

But it may not be until the spring or early summer that vaccines are available on a community level, though planning for distribution is underway.

“Our goal is to make vaccines at the community level as easy as possible to obtain,” Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said at a media briefing Monday. “So we want to stress convenience more than or as much as anything else. That means geographic convenience, such as not having to drive too far, as well as convenience with the process and not having to go through too many hoops in order to schedule a time to be vaccinated.”

Anne and Armand Bouchard. He asks, “How will they know the age we are and the Type 2 diabetes we have and how to put us on the list?” Brianna Soukup/Staff Photographer

The state is working with familiar vaccination sites like pharmacies, as well as exploring whether the swab-and-send COVID-19 testing sites set up this year could be converted to offer vaccines as well as testing, Shah said. He said the state is also working with EMS providers and first responders to see if they have the ability to vaccinate.

“None of those plans have been finalized,” Shah said. “The big variable is not so much our planning but literally how much vaccine will be coming into the state. Once we know what that looks like we can have a better sense of how broadly to distribute it so all those options are available to Maine people.”

How people are informed of the availability of vaccines may depend on which priority group they are in. The state is working off federal recommendations as well as its own vaccination plan. Essential workers and front-line health care workers may get notification through their employers that vaccines are available to them. Health care providers may inform patients, or the state could provide a general notification through its regular COVID-19 briefings with the media, Shah said.

Shah was asked Tuesday when older Mainers who aren’t in nursing homes might be in line for a vaccine. He hesitated to give an exact time frame, but predicted it would likely be in late January or February before that category is reached. “A lot really depends on how much is produced,” Shah said on Maine Public’s “Maine Calling” radio show.

Most Maine people who get vaccinated in later stages may get a vaccine that has yet to receive emergency authorization by the U.S. Food and Drug Administration, Shah said. He mentioned two – one from AstraZeneca and Oxford University, the other from Johnson & Johnson and Janssen Pharmaceuticals – that are in late-stage clinical trials, but still “several weeks if not months,” from being ready for distribution.

“It may be early spring before you hear from your health care provider (about scheduling a vaccine),” Shah said.

Some Portland-area physicians said Tuesday that they are telling patients that vaccines likely won’t be available to them until the spring if they fall outside the highest priority categories of health care workers and nursing home or long-term care residents and staff.

“We’re not sure of the timeline, because it really hinges on so many things that are out of our control, like how much vaccine the state gets from the federal government and how quickly that comes,” said Dr. Renee Fay-LeBlanc, chief medical officer at Greater Portland Health, a federally qualified health center. “So what I’ve been telling people, with the caveat that there’s a lot out of our control, is the time line for when vaccines might be available on a more widespread basis is around April.”

The center is starting to prepare, however, for what distribution might look like. It may hold clinics similar to a flu shot clinic, though Fay-LeBlanc said the coronavirus vaccine is a little more complicated. Patients with multiple health conditions might go ahead of others, and the two vaccines that are likely to be the most readily available, from Pfizer and Moderna, require boosters to ensure their effectiveness. “I think by the time April rolls around we’ll have a lot more guidance from the Maine CDC in terms of who to focus on first,” Fay-Leblanc said.

A draft vaccination plan created by the state in October provides a breakdown of the phases that should be prioritized for vaccines starting with high-risk workers in health care facilities and first responders, then moving to people of all ages with underlying conditions that put them at significant risk and older adults living in congregate or overcrowded settings.

The next phase includes people of all ages with underlying conditions that put them at moderate risk as well as all older adults not included in the first phase and essential workers including teachers, people who work in prisons and jails, and other workers “in industries essential to the functioning of society and at substantially high risk of exposure.”

Children and young adults are included in a third phase, while a fourth and final phase includes all Maine residents not included in previous categories.

Dr. Jabbar Fazeli, a geriatrician and owner of Maine Geriatrics in Biddeford, said he is advising outpatients and those in independent living that they might not receive vaccines until April, as the state’s next few shipments of vaccines will continue to go to health-care workers and nursing home residents.

The Maine CDC is expecting to receive 74,875 vaccine doses over the first three weeks of the vaccine rollout, including the Moderna vaccine that’s up for emergency review and approval this week. The state has an estimated 75,000 health care workers with direct patient contact and about 6,000 residents of nursing facilities.

Fazeli said it’s unclear when his staff might get access to vaccines. “There’s not a lot of talk about doctor’s offices,” he said. “There’s a clear plan for hospitals and nursing homes, but doctor’s office staff have to navigate that on our own. We’re calling Walgreens and telling them where our staff work, what their risk level is, that sort of thing, so we can vaccinate them when they’re due.”

The Pfizer vaccine is the only vaccine to gain emergency use authorization, but Fazeli said if the second vaccine from Moderna is approved it could make distribution easier and more accessible because that vaccine does not have the same ultra-cold storage requirements as Pfizer. With the Moderna vaccine, Fazeli said it would be easier to set up clinics or have his staff do house calls to vaccinate elderly patients.

The U.S. Centers for Disease Control and Prevention has said cost should not be an obstacle to anyone in getting vaccinated against COVID-19. Vaccine doses purchased with taxpayer dollars will be given to Americans at no cost. However, vaccination providers may be able to charge administration fees for giving the shot. Providers can get reimbursed for the fee through a patient’s public or private insurance company or through federal coronavirus relief funds, the U.S. CDC said.

Jackie Farwell, a spokeswoman for the Maine Department of Health and Human Services, said the agency has created a working group for the equitable distribution and uptake of COVID-19 vaccines that includes representation from a number of disproportionately impacted communities.

“The working group will work with local leaders to better understand hesitancy and barriers in their communities, and provide education and outreach information in a culturally and linguistically appropriate manner,” Farwell said in an email. “We’ve also been reaching out regularly to health providers about vaccine hesitancy in disproportionately impacted communities, and those discussions have included community advocates as well.”