Vaccine rollout hits major snags

“This should be D-Day right now,” said one expert. But it’s not.

Alhan Fadiani (right), doctor of pharmacy for CVS, and Donna Ko, pharmacist, prepared the Pfizer-BioNTech COVID-19 vaccine at the Soldiers' Home in Chelsea.Jessica Rinaldi/Globe Staff

US officials faced mounting criticism Tuesday for their slower-than-promised coronavirus vaccine rollout as a chorus of public health experts and President-elect Biden slammed what they said was poor planning and a lack of urgency about “getting shots into arms.”

“The Trump administration’s plan to distribute vaccines is falling behind — far behind,” Biden said, laying out steps he would take once in office to speed up the process. “At the pace that the vaccination program is moving now ... it’s going to take years, not months, to vaccinate the American people.”

Biden spoke after a parade of health experts, led by Dr. Ashish Jha, dean of the Brown University School of Public Health, lambasted the federal stewardship of what would be the biggest immunization drive in US history. Meanwhile, Colorado health officials reported the first known US case of a person infected with a highly contagious mutant virus strain that has circulated rapidly in the United Kingdom, leading to a widespread lockdown.

Jha and others charged that US officials were putting the burden for the vaccination effort on overstretched states, delaying funds to set up an infrastructure, and providing little guidance to states on how to prepare for administering the vaccines.

“I’ve had this fear for a long time that people in the White House and [US health officials] just were not paying any attention to this, and over the last few weeks, that has become really, really clear,” Jha, who first issued his critique on Twitter, said in an interview.

Planning for the critical “last mile” of vaccine rollout should have begun months earlier, Jha said, “so that the day the vaccine gets authorized by the FDA, every nursing home in America is ready to go with people lined up to vaccinate.”

He continued, “That’s what a government that cared about protecting lives would have done.”

Instead, he said, the vaccination push is running alarmingly slowly at a time when the deadly coronavirus is resurgent nationwide.

Federal officials had projected the United States would deliver 20 million vaccine doses by year-end. But in its most recent update Monday, the Centers for Disease Control and Prevention reported only about 11.4 million vaccine doses were shipped to states and 2.1 million people had gotten the first shots in their two-dose regimens.

“They over-promised, and now there’s under-delivery,” said Dr. William Schaffner, professor of infectious diseases at Vanderbilt University School of Medicine in Nashville.

In Massachusetts, where officials initially said they expected to receive an allotment of 300,000 doses by Dec. 31, that number was scaled back to 265,000 earlier this month after they were told initial US projections were wrong. Baker administration officials Tuesday said 257,750 doses have been shipped to date. As of Monday, they said, first shots had been given to 67,016 state residents.

Trump administration officials brushed aside criticism.

Michael Pratt, a spokesman for Operation Warp Speed, which coordinates the federal vaccination effort, attributed the shortfalls partly to delays in the reporting of administered doses. He said in a statement that the gap between the number of doses distributed and administered is expected at this point in the program.

Operation Warp Speed remains on track to allocate 20 million doses for the first of two required vaccinations by year-end, the statement said, “with distribution of the 20 million first doses spanning into the first week of January as states place orders for them.” He promised that the doses for everyone to receive their second shots would be “distributed a few weeks later.”

But the statement addressed distribution, not the crucial next step: inoculating people with the vaccine.

The stakes in the race to vaccinate Americans are rising as the CDC projected Tuesday that the number of COVID-19 deaths could climb to 400,000 by Inauguration Day.

With federal officials turning over vaccination planning to the states, officials there have been clamoring for funding to pay for the programs. Massachusetts officials have not said how much the vaccinations will cost, but they are working to identify pools of revenue — including $88.9 million from the COVID-19 relief bill signed by President Trump on Sunday — to defray costs.

Biden, speaking in Wilmington, Del., promised that in his first 100 days in office, 100 million vaccines will be administered — a feat he said would require vaccination to occur at five or six times the current rate. To support that acceleration, Biden said, he will use the Defense Production Act to order industry to produce vaccine materials and personal protective gear.

The president-elect tempered his ambitious tone with a warning that vaccinations will still take considerable time and effort. ”This is going to be the greatest operation challenge we’ve ever faced as a nation,” he said.

Dismay over the slow rollout, which has been brewing quietly among health leaders over the past week, burst into public view Monday night when Jha took to Twitter to express his frustrations. His thread garnered thousands of likes and retweets — and resonated with public health experts in Massachusetts and beyond.

Other health care leaders echoed Jha’s critique Tuesday, calling the federal response inadequate. They also questioned whether state health officials, underfunded and overwhelmed by 10 months of fighting the pandemic, were up to the task of organizing the “last mile” for final distribution of the Pfizer and Moderna vaccines authorized for emergency use earlier this month.

“Speed is what matters,” said David Williams, president of Health Business Group, a Boston management consulting firm. “This should be D-Day right now. But what’s happening nationally is it’s just being done in a bureaucratic manner and it’s not being done with the urgency you’d do in a civil defense or war-time exercise.”

Williams cited Oxford University data showing Israel, with a population not much bigger than Massachusetts, already has administered 5.68 doses per 100 people compared to the US total of 0.64 per 100.

“States have all submitted their plans to the federal government, but we have yet to see a coherent national plan that explains how they’re going to ramp up the speed [of distribution],” said Dr. Leana Wen, a visiting professor of health policy and management at George Washington University’s Milken School of Public Health.

Wen said that, by her calculation, the country would need to vaccinate 3.5 million people per day to reach 80 percent vaccination by the middle of next year, up from about 1 million per week thus far.

“You need to have a national strategy. It can’t be piecemeal. You can’t diffuse responsibility and accountability,” Wen said.

In Massachusetts, rollout at some hospitals has been rocky, with some front-line workers complaining that colleagues who don’t treat COVID-19 patients are skipping to the front of the line. At Mass General Brigham, the state’s largest hospital system, a computer glitch caused a vaccine sign-up website to temporarily crash.

But the biggest setback in Massachusetts came when federal officials told the Baker administration on Dec. 18 that their promised Pfizer vaccine shipments would be cut by 20 percent this month. Governor Charlie Baker said he was “frustrated” by the allotment reduction, which could delay the rollout by “a week or so.”

General Gustave Perna, the military leader of Operation Warp Speed, took responsibility for confusion over allotments to Massachusetts and other states, saying the week before Christmas that he gave incorrect guidance because he didn’t have “a clear understanding” of the vaccine distribution process.

For public health leaders, the federal support that was so crucial to developing the vaccine and beginning its distribution has fallen away now that it’s time to administer the doses.

“A lot of money has gone, quite appropriately, to the companies to develop the vaccine and test it, and to actually Warp Speed to deliver vaccines,” Schaffner said. “But at that point, the federal assistance stopped. The hard work is just beginning: Moving the vaccine from vials into arms.”