By Jared S. Hopkins and Arian Campo-Flores
Three weeks into the most ambitious vaccination campaign in
modern U.S. history, far fewer people are being protected against
Covid-19 as the process moves slower than officials had projected
and has been beset by confusion and disorganization in many
As a result, the federal government came nowhere close to
vaccinating 20 million people by the end of 2020, as it had
Of the more than 12 million doses of vaccines from Moderna Inc.
and Pfizer Inc. with BioNTech SE that have been shipped, only 2.8
million have been administered, according to federal figures.
The shortfall is due in part to a lag in reporting data using
new tools, government officials and health experts said. But as the
federal government has left it to states to determine what to do
with the vaccines it ships to them, and with some states pushing
decision-making to local health departments and hospitals, the
process has gone far from smoothly.
People in Florida are waiting in hourslong lines to get shots on
a first-come, first-served basis. Some West Virginians got a
Covid-19 treatment instead of vaccines. A medical practice in Texas
had only two workers sign up to take the shots. While some states
received fewer doses than they expected and some hospitals got
their first ones this week, other health care providers have more
doses than they know what to do with and are scrambling to find
enough syringes to use them.
"Hospitals aren't vaccinating everyone at the flip of a light
switch," said Claire Hannan, executive director of the Association
of Immunization Managers, which represents state immunization
officials. "There may have been an expectation from Operation Warp
Speed or others that we'd give everyone the vaccine overnight....It
was a logistics equation for them. If you've been in vaccines for a
long time, you know that's the easy part. Getting it into actual
arms is the hard part."
So far, vaccines have mostly gone to health care workers and
residents of long-term care facilities, in line with guidelines
from the Centers for Disease Control and Prevention. Essential
workers like bus drivers or grocery clerks, plus older adults, are
expected to be vaccinated next in 2021 as supplies increase and as
more vaccination sites come online. The slow rate of vaccinations
so far has raised questions about whether those groups will start
getting shots this winter and the rest of Americans in the spring,
as initially projected.
Moncef Slaoui, chief adviser for Operation Warp Speed, the U.S.
government's coronavirus response program, and other federal
officials said they hope the pace will increase. "We agree that
that number is lower than what we hoped for," he said at a news
briefing Wednesday. "We know that it should be better, and we're
working hard to make it better."
Public health officials and states say uptake is lagging for
several reasons, beginning with holiday seasons that have kept
staff of hospitals and nursing homes away from work. They also note
they are facing high percentages of people, including some health
care workers, who are skeptical of taking the shots.
Hospitals and other sites are staggering appointments to avoid
pulling too many workers from caring for patients amid a nationwide
surge in Covid-19 cases, officials say. Administration of the
vaccines also takes more time than a typical flu shot, particularly
since they are being done socially distant, and may be preceded by
a Covid-19 test.
In addition, people who receive vaccines are being monitored for
at least 15 minutes in case of allergic reactions. At least 11
allergic reactions to Covid vaccines have been reported, according
to the CDC. No serious safety concerns have been found, in line
with findings from the clinical trials.
The federal government is sending vaccines to states based on
their populations, and it has provided guidelines, but no rules,
about how they should be distributed. State and local jurisdictions
have been asking the federal government for more funding to support
vaccine distribution than the $340 million disbursed so far. The
economic stimulus package recently signed into law by President
Trump contains an additional $8 billion.
Different state policies have led to confusion and shipment
delays for hospitals, said Michael Wascovich, vice president of
field pharmacy services for Premier Inc., a group purchasing
organization whose members include 4,100 hospitals, 80% of which
"Every state is doing what they want to do," he said. "You could
be in Philadelphia and it's completely different across the river
if you're in Trenton or Camden."
Community Health Systems Inc., which operates 86 hospitals, is
seeking state permission to redistribute doses across its Florida
hospitals, while three hospitals in Indiana got no vaccine and
workers must get shots elsewhere, complicating efforts to track
company immunization rates. "It's not within our control," said
Lynn Simon, the hospital system's chief medical officer. "It is a
little anxiety producing."
In Grand Rapids, Mich., Spectrum Health had lowered supply
estimates as the state repeatedly revised projections. Hospital
officials were stunned to learn two days before Christmas they
would get 60% more than expected of Pfizer's shot and more than
double Moderna's, said Chad Tuttle, senior vice president of
operations across Spectrum's 14 hospitals.
Many states are following CDC guidelines to start with
front-line medical workers and people in long-term care facilities,
but not all. Florida Gov. Ron DeSantis on Dec. 23 extended
eligibility to people aged 65 and older.
Because each county and hospital in the state implemented its
own approach, many people didn't know whether to call, log on or
show up in person to secure a spot.
Officials in Lee County, home to Fort Myers, learned last
Saturday that the county would be one of eight in the state
receiving doses the following day to inoculate people 65 and older,
said Kevin Ruane, chairman of the county commission. With the local
health department thinly staffed, they rushed to enlist paramedics
and others. They weren't able to set up a reservation system,
leading to hundreds of people lining up before dawn.
"It's a logistical nightmare," said Fort Myers Mayor Kevin
Frustrated by the slow pace of inoculations, Arizona Gov. Doug
Ducey issued an executive order Wednesday directing the state
health department to create a vaccine-allocation system and
allowing the agency to take possession of doses for
Forty-two people in West Virginia were mistakenly given
Regeneron Pharmaceuticals Inc.'s antibody treatment designed to
fight Covid-19 in those already infected instead of Moderna's
vaccine. None are at risk of being harmed, according to the West
Virginia National Guard.
In Hidalgo County, Texas, one medical practice received 1,000
doses for health-care workers, but only two people responded, said
Ivan Melendez, the public health authority for the county near the
"I think there was an overestimation of the numbers," Dr.
Melendez said. "All of a sudden, there's a glut of vaccines."
More than 167,000 doses have been administered at long-term
medical care centers. Facilities are getting shots at varying rates
via drugstore chains CVS Health Corp. and Walgreens Boots Alliance
Inc. because states met the requirements to begin the distribution
program at different times.
CVS has begun administering doses at nursing homes and
facilities in 48 states and Washington, D.C., with most eligible
residents agreeing to be vaccinated, said Chris Cox, a CVS
executive who is overseeing the vaccination rollout for the
In some cases, residents haven't been vaccinated because of
active outbreaks at facilities, while other facilities have taken
longer than others to schedule their vaccination clinics, a
challenge exacerbated by the holiday season, Mr. Cox said.
West Virginia is the only state to report having delivered the
first of two vaccine doses to all of its approximately 200
long-term care facilities. More than 80% of eligible residents have
been vaccinated because the state relied on some 50 local
pharmacies, said Martin Wright of the West Virginia Health Care
Association, a nursing home trade group.
Many hospitals saw an opportunity to inoculate more people after
discovering Pfizer's vials yielded six or seven doses instead of
five due to so-called overfill, which typically happens with
vaccines. The development sent hospitals scouring for more syringes
and needles to utilize the extra doses, said Mr. Wascovich of
"They all value it like it's worth its weight in gold," he
Now, some public health officials are concerned the country may
not be ready for the next phase of vaccination, expected to include
essential workers such as grocery store clerks or
The U.S. health system and its stretched local health
departments weren't prepared for the volume to vaccinate an entire
country in a few months, according to Ms. Hannan, the director of
the immunization association.
"The real challenge is around what happens when we get a larger
supply and what happens when we have to vaccinate people that don't
work in a hospital," she said, noting that fewer physicians'
offices and health clinics have signed up as vaccination sites than
Vaccination for the next priority groups, 49 million elderly
people and front-line essential workers, such as teachers and
grocery store workers, is expected to begin in the coming weeks,
according to health experts. Delays so far could push back the
start dates of those programs, however.
In addition, states will likely make different determinations
about who counts as essential and which groups go first,
potentially frustrating the public, health experts warn. Prison
guards in one state might get inoculated months before those in a
"Those could be points of confusion in the week ahead as people
try to figure out, 'Where am I in line?' " said Dr. Kelly Moore,
associate director of immunization education at the Immunization
--Melanie Evans contributed to this article.
Write to Jared S. Hopkins at firstname.lastname@example.org and Arian
Campo-Flores at email@example.com
(END) Dow Jones Newswires
January 01, 2021 13:43 ET (18:43 GMT)
Copyright (c) 2021 Dow Jones & Company, Inc.