Maryland residents 65 or older who live in congregate care settings and residents with compromised immune systems can now receive a third shot of a COVID-19 vaccine, Gov. Larry Hogan announced Wednesday.

The governor’s authorization of third shots — a first for the D.C. region — comes even as federal officials hold out on issuing formal booster guidance, and as world leaders urge wealthy countries to pause third dose distribution. Last month, the Food and Drug Administration authorized the emergency use of both Pfizer and Moderna vaccines to allow for a third dose in immunocompromised residents, but the White House has been reticent to announce a booster plan for other Americans.

“Unfortunately for several weeks now, states have had to operate without clear guidance from the federal government regarding these booster shots,” Hogan said during a press conference Wednesday. “The limited guidance we have received has been confusing and contradictory, and it is still unclear when and how more people will become eligible, but all of the evidence makes it abundantly clear that we cannot afford to delay taking decisive action to protect our most vulnerable citizens.”

According to Hogan, starting immediately, any resident 65 and older that lives in a nursing home, assisted living facility, residential drug treatment center, or a group home can receive a third dose. Pharmacies and health care providers are also instructed to offer a booster shot, without a prescription or doctor’s order, to any resident that considers themselves to be immunocompromised. According to Hogan, some providers may ask a patient to fill out a form, but “no one in this category should be turned away from receiving a booster.” A spokesperson for Hogan confirmed to DCist/WAMU that the boosters are only available for residents who received a Moderna or Pfizer vaccine.

Hogan cited an antibody study conducted in nursing homes across the state by the Maryland Department of Health, which found that 60% of vaccinated residents demonstrated reduced immunity to the virus over time. To date, he said the state has already administered 28,000 boosters to immunocompromised residents.

The state reached a major goalpost in its vaccination campaign this week, reporting that 95% of residents 65 and older are at least partially vaccinated against COVID-19. The state also exceeded its goal to partially vaccinate 80% of adults by Labor Day: As of Wednesday, 80% of all residents 12 and older are partially vaccinated. On Wednesday, Hogan said the state is now launching a $3 million statewide canvassing campaign, knocking on doors in areas with low vaccination rates.

“With our focus on preventing hospitalizations and deaths, our public health response has evolved from an initial strategy of containment, to mitigation, and then to vaccination,” Hogan said. “And now as we approach the fall we’re moving into the new phase of maintaining immunity.”

Since the spike in cases began in late August, the state’s positivity rate, which measures the number of infections out of total tests administered, remains high, but has plateaued in recent days. The average rate of new cases per 100,000 resident has also dipped slightly since the first week of September, but remains at a level not recorded since April. Meanwhile, hospitalizations continue to rise, and more Maryland residents are dying of COVID-19 in Maryland than at any other point throughout the past spring and summer. As has been the case with other case surges in the pandemic, an increase in hospitalizations and deaths typically lags behind a noticeable upward case trend.

When asked whether the state’s move — overstepping and expediting the federal government’s booster distribution — will only contribute to more confusion, Hogan said: “no.”

“I think we’ve been about as clear as you could possibly be for 19 months and we’re gonna keep being as clear as we can,” he said.