Why Is It Taking So Long to Administer COVID Vaccinations?

It’s been just longer than two weeks since the first batches of Pfizer’s COVID-19 vaccine began rolling out nationwide, and 10 days since Moderna’s did the same. According to CDC data, a combined 12,409,050 doses of these two vaccines—both of which were developed and received FDA authorization in less than a year—have been distributed across the country, and 2,794,588 of those doses have been administered. 

In a vacuum, inoculating nearly 3 million people against a deadly virus less than a year after it was sequenced is nothing short of a miracle. But given that the daily death toll in the U.S. has averaged nearly 2,500 this month, some are saying it’s not good enough.

“The Trump administration’s plan to distribute vaccines is falling behind,” President-elect Joe Biden said on Tuesday. “We are grateful to the companies, the doctors, the scientists, the researchers, the clinical trial participants, and Operation Warp Speed for developing the vaccines quickly. But as I long feared and warned, the effort to distribute and administer the vaccine is not progressing as it should.”

Biden referenced Operation Warp Speed chief Moncef Slaoui’s suggestion that 20 million Americans would be vaccinated by the end of the year, pointing to the CDC’s relatively meager 2.7 million figure. “At the pace the vaccination program is moving now,” he said, “it’s going to take years, not months, to vaccinate the American people.”

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  • "The vaccination program is falling woefully behind. With hundreds of thousands of lives at stake, urgent action is needed on a comprehensive vaccination plan that states can use as a model."

    and

    “That comprehensive vaccination plans have not been developed at the federal level and sent to the states as models is as incomprehensible as it is inexcusable."


    -- US Senator Mitt Romney (R-Utah)


    https://www.romney.senate.gov/romney-urgent-action-needed-vaccination-plan

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  • I think that another bottleneck is identifying the people who we’ve decided should receive the vaccine first. The elderly and those with comorbidities have been receiving e-mailed “invitations” to take the vaccine from hospitals at which they’ve been treated. Some have received multiple invitations from different hospitals and clinics.

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  • Another reason why it’s taking so long to administer the COVID vaccine may be that after all the politicization of the pandemic by both sides, many people simply do not trust anybody in authority telling them what they should do. They are either afraid of the vaccine or don’t know what to think, and are therefore opting out of vaccination, at least for now.

    An anecdote. A friend of mine works in a hospital. All staff there were given the opportunity to be vaccinated, but only half (including my friend) chose to do so. Half. Furthermore, in at least one department, staff were telling patients not to be vaccinated when the vaccine becomes widely available. I would like to think this is an isolated case of distrustful and fearful staff in a dysfunctional hospital, but my friend, based upon extensive experience in the field of health care, doesn’t think so.

    Is there any data indicating what percentage of health care workers are refusing to take the vaccine when given the opportunity? If half of them are opting out, we have a problem.

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  • Politicians are good (defining that term loosely) at campaigning, not governing. the problem is in the states. If the Empire state didn't have a plan in place prior to Labor Day, then blame the granny-killer, not Uncle Sammy.

    Anything that requires logistical coordination requires people to map it out in advance, and to make tough decisions in advance. It requires examining the choke points, and asking what can delay it, then designing the system to account for that. For example, You know you need to give shots in every nursing home in the state. When did the state first ask each nursing home for a count of residents? When did the state ask each nursing home how large of a facility did they have for administering the shot? How many shots can be given at a single time (e.g. if you have room for a single station, you can do perhaps 4 shots an hour, 36 shots per 10 hour day. BTW, my (now deceased) Father's nursing home has room to administer 6 shots in its primary health clinic, 2 in the library, 2 in the beauty parlor, and 2 in the staff break room, but you'll need 2 staff per room, plus at least one more staff coordinating. So if you don't have 9 staff ready to go, you'll be slow vaccinating.

    My guess is the states did not have sufficient plans in place, and are now scrambling, and are hoping Biden will flood them with money to administer the vaccine. Biden is cynical enough to know that congress won't dare vote against flooding the states with vaccine money, because it is a bad look to do so.

    I read in the WSJ that several pharmacy chains began, in December to rapidly ramp up staffing to get ready to go. Except nearly all of them take 2 months to on-board someone, so they won't be ready to go until February, and not up to speed until march (yes Virginia, there is a learning curve to doing this).

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  • "That comprehensive vaccination plans have not been developed at the federal level and sent to the states as models is as incomprehensible as it is inexcusable"


    -- Former Republican Mitt Romney

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  • Really appreciate the many-faceted fairness and detail in this article.

    CVS is scheduled to bring the first dose to the SNF where I work on Monday and Wednesday. Will be working longer hours next week as one of our therapists tested (+) on Friday, so we're short-staffed. Add to that our "COVID" unit has jumped from 9 to 17 patients in a week. There's talk of blocking off a whole unit for them.

    We have only one staff member with my credential (occupational therapist) who's previously had a (+) test for COVID, and she's having to see patients alternate days on the COViD unit to provide everyone therapy. Many of us, including me, had symptoms in March - a (-) swab for the flu in my case - but there was no testing then, and most of us don't have antibodies at this time, per blood donations.

    Nobody wants to volunteer because we don't get as good of PPE as in hospitals. For instance, none of us have fitted N95 masks. Our CNAs and housekeeping staff were hit very hard and early by the virus, as many of them live in multi-generational homes with other "essential" workers, so there's no shortage of them to work the COVID unit.

    After my first dose, I'm thinking of volunteering to work that unit to relieve my co-worker, but it's scary. I have a sick dog who needs meds 3X/day, and she has behavior problems. She goes to a special day care where she could, in theory, board if I got hospitalized. However, separation stresses her and might bring on more seizures. None of the people who used to dog sit can I ask to do that during COVID.

    Certainly, it's even more difficult for people with children, but they might have extended families who could help. If something happens to me, there's nowhere my dog could go. She's not adoptable, and she's near the end of her life.

    It's crazy I'm still having to consider these contingencies in the New Year. Looking forward to spring, summer.

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  • I work in healthcare and helped staff the COVID vaccine clinic when we rolled this out. It was almost certainly always going to be this way.

    First, we have weary staff that is facing a renewed COVID surge and there are fewer available to be pulled off their regular duties to assist with vaccination. Hire more you say? That's a great idea, and we had planned for that. We have also put out calls for those that have retired to help.
    We have conscripted pharmacy students to assist with preparation and administration. We've had our current staff pick up extra shifts. However, the great unknown was if/when a vaccine would be approved. Hiring and training people takes time and without a known time when someone is needed, it is difficult to plan.

    Next, while some specifics were known about the vaccines until the FDA has approved the EUA, the information is released, and we actually get some hands-on experience with the product there is only so much you can do to prepare. A great example of this is how the original manufacturer-approved labeling was for 5 doses per vial for the Pfizer vaccine. However, we quickly discovered we could get at least 6 doses from each vial. This is but one example, but there are many others.

    Also, along those lines, as it is well known, the Pfizer vaccine requires an ultra-low freezer for storage. There are only so many facilities with those freezers and while more would be great and help expedite distribution, the supply chain for them and also dry ice for shipping has come under pressure. The easier storage of Moderna will help reach more people faster, but when your distribution is limited, the rate at which you can vaccinate people will be similarly constrained.

    There have been conflicting messages from the CDC and our state government and some rollout issues with the latter have affected the implementation in my view. However, on the ground, no one is caring about the stupid politics and issues associated with it. Everyone is doing their best to increase our clinic throughput, extend hours, and vaccinate as many people as possible. We started vaccinating the week after the Pfizer vaccine was approved and have hit a high every single successive weekday excepting those right around the holidays. We have prioritized our front line clinical staff, most critically those in the ED and ICUs. We were about a day away from running out of vaccine before Moderna's arrived. Part of the slower uptake too is we have basically maxed out our current capacity because starting next week we are now facing the issue of having to double capacity next week as we seek to give everyone their second Pfizer vaccine and still continue to vaccinate new people. We planned for this, but space and staff constraints are one reason why many places perhaps aren't blowing through the vaccine because in 3-4 weeks the demand on staff is going to be even greater. You have to set up an operation that you can safely maintain.

    These all present large logistical, staffing, and supply chain problems that are being handled by healthcare workers who already had plenty to do before the vaccine became available and now we are also experiencing a surge and an even more contagious variant of coronavirus. We're tired and we're doing our best. In the meantime, please continue to physically distance and wear a damn mask when appropriate.

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    1. Thank you for this comment as it really helps illustrate the difficulties in rolling out this vaccine. Also, it's great to hear that your people are ignoring the petty politics around this pandemic and are doing what's best for your staff and patients.

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    2. Haywood, thanks for this great info. You’ve explained it much clearer than I could! Stay safe and God bless.

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    3. Thanks so much for this perspective. It helps and I will probably be pointing other people to both Declan's article and your comment for some balance. Armchair quarterbacking when you don't really know the issues involved is very easy and very tempting. Thanks for taking the time to write this post. And as the military likes to say "No plan survives first contact with the enemy", or in this case, Hope and Expectations are usually gonna outrun reality.

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  • I am not a Trump fan, however in blaming the states for a slow rollout of vaccines, he is correct.

    In NY, our governor has close relationships with the CEO’s of hospital systems. He decided that these hospital systems, such as Northwell Health, Westchester Medical Center, Albany Medical Center, and SUNY Upstate, would be the regional hubs for vaccine distribution. All vaccine has been shipped to them, and is under their control.

    Our local health system is a regional vaccine hub. They own 23 hospitals. In two weeks, they have vaccinated 5,000 out of their 74,000 employees. At this rate, it will take them seven months to vaccinate all employees, without calculating for the second vaccine, which must be given 3-4 weeks after the first, and will further slow the process.

    Hospitals are already overwhelmed with Covid, and this will get worse over the next two months. They have no spare staff, no space, and no funding for a mass vaccination campaign. They are slowly going through their list, a few vials at a time, often requiring employees to travel to a facility other than the one they work at to be vaccinated. They also need to account for employees having side effects from the vaccine, so they say they can not vaccinate a whole department at once.

    This is not efficient. The hospitals have no incentive to move faster. Their administrators have already received vaccines despite having no patient contact, and those who do money-making surgeries were also first in line. There is no revenue in vaccination.

    Yet, the hospitals are not releasing vaccine to anyone else, and the process is stuck in slow motion. Cuomo should have known that hospital CEO’s would not look out for the good of the people of New York State. Mass vaccination campaigns are not their area of expertise and in their defense, they are swamped with dying patients and bleeding money.

    Meanwhile, thousands of healthcare workers are ready to volunteer nights and weekends to vaccinate the public ASAP. Other healthcare organizations have offered to donate personnel and equipment at no charge.

    NY should set up regional vaccination locations in the state’s biggest parking lots. Have people register for a time slot, drive up and park in rows. Vaccinate them in their cars and have monitors watch them for 15 minutes and then volunteer traffic controllers will send them on their way.

    Healthcare organizations (not hospitals) have also registered with the state to be mobile vaccine units. They are ready to drive into underserved areas and vaccinate. They want to go to fire and police stations. But they have no vaccine because it is sitting in hospital freezers.

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    1. The power of hospitals is an issue in a lot of states. I work in a nursing home, and one of our sister facilities was swamped with COVID+ patients last spring, except they hadn't been tested before they were sent out. It was in the hospital's interest to let the patients be tested for COVID upon arrival at the nursing home, and therefore show up in that facility's stats vs the hospital's stats. The risk of sending potentially COVID+ patients into a setting with a vulnerable population, with a staff without access to high quality PPE, and with (honestly) less stringent infection control, was regarded as of less importance than keeping to the business as usual practice of transferring less profitable / unwanted patients to lower status facilities like nursing homes.

      Now, in my area, all sorts of hospital staff - social workers, therapists - are getting the vaccine weeks before nursing home residents, RNs, LPNs, CNAs. I know this because all my former classmates who work in hospitals are on my social media feeds posting pics of themselves getting vaccinated.

      If some central administrator were directing vaccine distribution for the public good, the most vulnerable - e.g. the elderly - would be vaccinated first. Had two patients test (+) for COVID in the last few weeks. As I was waiting on the results of my twice weekly PCR tests to come back, my overwhelming concern was that *I* was not the person who infected them. (I wasn't, fortunately.) If vulnerable people were first in line, I could stop living in terror about exposing them to this virus. We have a very, very status-conscious healthcare system, and power naturally trumps vulnerability in a system like that.

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      1. Thank you so much for your work. I often think of how little we prioritize nursing homes, even in non-pandemic times. We need so much more regulation, oversight, funding, and compassion.

        It is very frustrating that NY State has given complete power over the vaccines to the CEO’s of these large hospital systems. It was hard to know that they vaccinated administrators who have worked from home since March, the deans of the medical school and head of departments, before respiratory therapists and ICU nurses. Of course the large healthcare “hubs” are not interested in releasing vaccine to independent doctors, and other organizations who are their competition. I don’t see how they have any plan, experience or ability to vaccinate the general public. My hope is that the governor will be under a ton of pressure to create a new system.

        I very much hope that your facility receives their vaccines ASAP. In the meantime, I am praying for you and your patients.

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        1. CVS is bringing the first dose tomorrow or Wednesday. So I should get some sleep!

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  • Hiccups in the initial phase of the vaccine rollout don't surprise me one bit, especially when it happens in the middle of the holiday season AND continued political insanity. Yes, we need to do better. Yes, I believe we WILL do better. One thing that'd really help? If more people focused on working the problem and not on looking for ways to use the issue to dunk on politicians they don't like. Sadly, I don't see that happening anytime soon.

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    1. Hear, hear. Freaking out about an incredibly complex undertaking having some issues getting started is a bit silly. Lets take a breath and give people time to work out some of the wrinkles.

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      1. Oh, I understand the freaking out. Case and death counts are still seriously high, businesses are going under, and everyone's looking to these vaccines as the key to making things feel closer to normal. I just wish they'd direct their energy to more productive ends than insults and scoring political points. But this is the world we live in now, where EVERYTHING is political. "Thanks, I hate it"

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      2. I've been trying to point out the level of complexity involved here, but all everyone wants to focus on is how it could be better. Like that's NEVER been said about anything done by government in the history of Ever. . .😡

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        1. It’s so silly honestly, because so many of the critics were the same saying we will never have a vaccine by the end of the year let alone start distributing it.

          It’s why I just don’t listen to the incoming administration on this, that got the predictions wrong and also spread ant-vaccination hysteria (looking at you Harris). Better luck to them on other issues.

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        2. It's both things -- it IS a complex process (although a lot of tabletop logistical gaming should --was?? -- have been going on since spring) AND the leadership at the top royally sucked, and that's a huge fault line.

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          1. Yes, but look at the comments here. The majority are laser-focused on Trump failures and dont bother to mention the underlying complexity at all.
            And let's not forget to acknowledge the many systemic failures of the CDC this year that had nothing to do with anything Trump touched. Testing (for one) would have been lousy regardless of who was in the White House back in the beginning.

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        3. Yeah, I kind of chuckle at the idea that if only the Federal Government had taken a bigger role, this would all be going smoothly... right. There's been a few articles written about the FDA's bureaucratic delays in getting the authorization issued. I think there is a strong case to be made that simply their delay in scheduling the stinking meeting after the outcome was a foregone conclusion probably cost several days.

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