Drs. Peggy Pennoyer and Don Endrizzi came out of retirement this month to help Maine Medical Center launch an effort to vaccinate thousands of front-line health care workers against COVID-19.

They have witnessed the joy and relief of weary intensive care and emergency department employees who were among the first people in the United States to be inoculated. And they have felt the reward of being part of a potential solution to a pandemic that has threatened and killed many health care workers and others.

“It’s our way of giving back,” Endrizzi said. “We both just retired, so we have the time, and by pitching in we help the medical center continue to function while workers are vaccinated.”

The Scarborough couple are part of a small army of volunteers who are helping Maine Med and other hospitals deliver COVID-19 vaccines as quickly as they arrive, in a process that’s more labor-intensive and time-consuming than some anticipated. The demand for additional workers to fill the staffing gap, whether paid or unpaid, is only expected to grow.

At Maine Med alone, more than 300 retired nurses, doctors, students in medical fields, hospital employees between shifts and others have stepped up to help paid staff and fill a critical need at the start of a statewide vaccination effort that’s expected to last through most of 2021.

About 70 employees of the Central Maine Healthcare system based in Lewiston have volunteered to help vaccinate their co-workers on their own time, and Brewer-based Northern Light Health has enlisted students in advanced health care fields with the potential to bring in volunteers in the future.

The crucial role that volunteers played in staffing the first two weeks of Maine’s vaccine rollout suggests a shortage of qualified vaccinators and a need for volunteers, both clinical and clerical, that will grow as the inoculation effort expands into the community amid a surging pandemic.

Walgreens, CVS and other national pharmacy chains this month announced plans to hire more than 40,000 pharmacists, technicians and other workers to staff vaccination clinics at long-term care facilities and other locations across the country. The University of New England is among several institutions, agencies and organizations in Maine that have offered to provide volunteers, including students, professors, dentists, hygienists and the state’s civil air patrol, according to the Maine Center for Disease Control and Prevention.

But while state officials say they have been planning the vaccination program for months, and they’re hoping for more federal money to carry out the program, Maine’s COVID-19 interim draft vaccination plan doesn’t address how it will staff an effort that anticipates vaccinating more than 1 million people over the next six to nine months.

The plan identifies 468 potential partners in the rollout, including hospitals, pharmacies, municipal health departments, and businesses, but it doesn’t say exactly who will operate vaccination clinics and administer doses while those partners also maintain normal operations.

And while the volunteer response so far has been greatly appreciated, there is growing concern that the COVID-19 vaccination effort is too complicated and critical to be dependent on volunteer staffing, with strict federal record-keeping requirements, pandemic-related public health protocols and demand that are far greater than the flu shot.

“The more you get into it, the more you realize this is a massive undertaking,” said Dr. Dora Anne Mills, chief health improvement officer for MaineHealth, the medical group that includes Maine Med in Portland. She’s one of several MaineHealth executives who have volunteered at vaccination clinics. She’s also former head of the Maine CDC and Gov. Janet Mills’ sister.

“This is the largest vaccination campaign in world history,” Mills continued. “This is an all-hands-on-deck effort. We’re all going to be heavily reliant on volunteers, but it cannot be sustained by volunteers alone.”

The state’s partners in the vaccination effort will make staffing decisions, just as hospitals and pharmacies are doing now, said Maine CDC spokesman Robert Long.

Maine’s previously established immunization program has a system in place to vaccinate people against influenza and other vaccine-preventable diseases, Long said. That system provides a foundation for COVID-19 vaccination, but additional federal funding will be critical to the success of Maine’s vaccination effort, he said.

And like other aspects of the pandemic response, figuring out how to staff community vaccination clinics may be put off until it becomes a pressing issue, when more vaccine becomes available and more groups become eligible and likely eager to be vaccinated.

“Questions persist about the federal government’s allocation plan and ongoing provision of these lifesaving vaccines,” Long said. “A clearer sense of the cadence of vaccine delivery to Maine for public vaccination will be needed to determine the total number of vaccinators who will be needed months from now.”

Recognizing the growing need, the University of New England is organizing and training a large contingent of students and faculty to help staff vaccination clinics in both clerical and clinical positions, said Jennifer Gunderman, a professor of public health and epidemiology who heads the university’s workforce development team.

The effort will include more than 200 students in the university’s medical, pharmacy, physician assistant and nursing programs, and the staff members required to oversee them in the field. It’s being coordinated with MaineHealth, the Maine CDC and Guardian pharmacies in congregate facilities, and it will help students who have yet to fulfill required clinical practice hours, in part because of the pandemic.

“Knowing this is a marathon, I’m thinking we could have more than 300 students involved in the work,” Gunderman said. “We’re looking at deploying UNE people throughout the state.”

As of Wednesday, MaineHealth had administered the first of two doses of the Pfizer vaccine to 5,200 employees across 10 hospitals. Front-line health care workers have been given top priority for inoculation because COVID-19 has infected at least 322,488 health care workers nationwide, according to the U.S. Centers for Disease Control and Prevention, and killed at least 2,921 of them, including three in Maine, according to The Guardian and Kaiser Health News.

By Saturday, the Maine CDC reported that more than 16,000 Mainers had been vaccinated, including nursing home residents and employees and emergency responders, with plans to expand the rollout to residents of assisted-living facilities this week.

By the end of Wednesday, Northern Light Health, which includes Eastern Maine Medical Center in Bangor, had vaccinated 3,000 workers among its 10 hospitals, medical practices and home care agencies using paid staff or students in advanced health care fields as part of their training.

“We are confident that Northern Light Health has the staff and other resources sufficient to carry out this important work,” said spokesman Andrew Soucier. “During our response to COVID-19, we have contacted retirees and others to be part of our surge planning, and several of these individuals have contacted us to ask how they can help. This may become necessary when supply of vaccine increases and we begin vaccinating the general public.”

Central Maine Healthcare, which includes Central Maine Medical Center in Lewiston and Bridgton and Rumford hospitals, had vaccinated 1,280 front-line workers with the help of dozens of “hero-volunteers” working on their days off.

“These hero-volunteers came from many parts of our organization and included providers, trauma surgeons, office managers, administrative assistants, coordinators, preceptors and system directors,” said Dr. John Alexander, chief medical officer. “It was an uplifting experience filled with camaraderie and hope, and we saw many repeat hero-volunteers.”

While the COVID-19 vaccine is generating a sense of relief and goodwill for many health care workers, the inoculation clinics are turning out to be more labor-intensive and time-consuming than some expected.

Maine Med has been holding its clinics right next door in the Dana Health Education Center, where 11 vaccination stations have been set up in several classrooms. The hospital plans to set up nine more vaccination stations at another site to increase its vaccination capacity and maintain COVID-19 safety protocols for physical distancing, Mills said.

The clinics run for about 12 hours each day, from late morning until midnight, and require 30 to 50 volunteers to help staff various clinical, clerical and maintenance positions. Each person vaccinated must be screened for health status and eligibility, registered in a database that asks a variety of questions, scheduled for a follow-up dose, inoculated by a trained person, and observed for 15 to 30 minutes to ensure there is no adverse reaction, all while maintaining COVID-19 public health protocols. The whole process takes 30 to 45 minutes.

Hospitals in the Central Maine Healthcare network have been able to vaccinate up to 30 individuals per hour, with two volunteers greeting and registering recipients, two volunteers performing vaccinations and one volunteer observing recipients for 15 minutes after vaccination.

“We learn a lot at each of our vaccine clinics and continue to refine our processes,” Alexander said. “We are coordinating our plan for vaccinating community members as a system, using our experiences from vaccinating our team members to understand what the vaccine delivery system will need to look like.”

Alexander said Central Maine will likely continue to hold larger vaccine clinics at its major campuses in Lewiston, Topsham, Bridgton and Rumford, and it will develop plans to have vaccine available at several of its medical practices, as it has for COVID-19 testing.

As health care providers and others ramp up Maine’s COVID-19 vaccination effort, volunteers already in the trenches are seeing the benefits of their contribution.

When Peggy Pennoyer vaccinated one Maine Med employee, a nurse who cares for COVID-19 patients, the young woman dissolved into tears.

“She was sobbing,” Pennoyer recalled. “I wanted to hug her, but I couldn’t. With the level of stress they’ve been under, it just came pouring out of her.”

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