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Dr. Ashish Jha, the dean of Brown University’s School of Public Health, warned he was about to unleash “a bit of rant” on Twitter Monday night before unpacking “the slow vaccine rollout” unfolding throughout the nation in a lengthy thread.

“Personally, I’m incredibly frustrated,” wrote Jha, one of the most quoted public health experts throughout the pandemic. “Did we not know that vaccines were coming? Is vaccine administration a surprise?”

Jha noted that “several complex issues” are at play when discussing the vaccine rollout and current frustrations surrounding the process.

First, Jha pointed out, Secretary of Health and Human Services Alex Azar told The Hill in October that “we’d have 100 million doses by [the] end of December.”

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At the time, the publication noted, this could translate to the US having enough of the vaccine “for every American by March.”

“Then, by November, Azar was saying 40 million doses [were] ready to ship out by [the] end of December,” Jha wrote. “Now, we’ll miss [the] 20M deadline but might be able to get to 20M by sometime in early January.”

But, Jha, wrote, “this is really not the worst part.”

The worst part, he explained, is the lack of planning on what happens when the vaccines actually arrive in states.

“No plan, no money, just hope that states will figure this out,” he wrote.

On the state level, departments of health are already strained and overburdened, Jha wrote.

“These well-funded agencies (yes, I’m kidding) who manage all the testing, data analysis [and] reporting, providing advice to businesses, schools, doing public campaigns, etc.,” Jha wrote. “Non-stop. For [nine] months. They get vaccines too.”

Most of the departments are “super stretched,” but are still trying to make a plan — despite a lack of resources and assistance from the federal government, Jha wrote.

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“They are trying to stand up a vaccination infrastructure,” Jha wrote. “Congress had given them no money. States are out of money. So many are passing it on to hospitals, nursing homes.”

Jha added: “Any of this familiar?”

He likened the ongoing rollout to “our national testing debacle” — and said the same problems that happened then are now being repeated.

“And now, hospitals and clinics are scrambling to figure out how to implement,” Jha wrote.

Referencing a CNN article on the situation, Jha pointed to one line from Mississippi Health Officer Dr. Thomas Dobbs that he said drove him “crazy.”

“The line when [the] Mississippi health chief says [it’s] not [the] state’s job to ensure vaccines get into people’s arms,” Jha wrote. “What? Whose job is it? Not the Feds. They just get vaccine to states. Not the states. They just get vaccine to hospitals, clinics.”

“So [it’s] all on front line providers?” Jha wrote.

Despite this, Jha noted that “many states” are stepping up to the task and “taking real responsibility.”

“LOTS of overburdened public health folks are still making this work,” Jha wrote. “Heroically.”

But because of the issues, Jha explained, hospitals are “trying to figure out where to set up vaccination sites” while others in charge are attempting to sort out “who can do vaccinations in care facilities.”

Jha also detailed “a few key data points:” the US has distributed about 11.5 million doses, approximately 2.1 million have been given to people, and he thinks “the real number given is higher (reporting lag) but [it’s] still not that great.”

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The part that is the “most frustrating,” to Jha, however, is that “there appears to be no investment or plan in the last mile.”

There has been “no effort” from the federal government to help states “launch a real vaccination infrastructure,” he wrote.

“Did the Feds not know vaccines were coming?” Jha wrote. “Shouldn’t planning around vaccination sites, etc. not have happened in October or November?”

Public health, Jha wrote, has always been a collaborative effort between states and the federal government, but now “states are stretched” at a time when those in charge are “[supposed] to help.”

“But [the] same folks who blamed states for [the] testing mess [are] now ready to blame states for [the] vaccine slowdown,” Jha wrote. “They are again setting states up to fail.”

All that aside, Jha wrote, “there is hope.”

Congress has finally passed the allocation of funds for vaccine distribution, Jha wrote, and states are now building infrastructure — something that “should have been built by Feds months ago.”

“After a slow ramp up, it’ll get better,” Jha wrote. “We’re learning again we can’t fight [the] pandemic with every state on its own. An effective federal [government] helps.”


Shannon Larson can be reached at shannon.larson@globe.com. Follow her on Twitter @shannonlarson98.