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Why is the U.S. COVID vaccine rollout going so poorly and slowly?

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This is a complicated question, as there are many different factors that have contributed to problems with the COVID-19 vaccine roll-out in the United States. 

Indeed, it’s worth stepping back to acknowledge how immense and complex a challenge it is to not just create an effective vaccine in less than a year, but to physically vaccinate 300 million Americans at a time when more than 20,000 people are dying every week. As “Science” editor-in-chief Holden Thorp put it on the PBS NewsHour: “[300 million Americans means] 600 million vaccine doses. That’s 600 million hypodermic needles. That’s 600 million appointments to go get your vaccine.”

With that being said, here are a few of the big reasons why the roll-out has not been as smooth as desired.



State and city governments are having to work with healthcare providers on a wide range of difficult logistical challenges, particularly with what’s known as “the last mile” – that is, the journey that takes vaccines from their centralized distribution centers to the clinics and hospitals that actually vaccinate patients.

It’s been hard to find suitable spaces for distribution where hundreds of people can stand in line and get vaccinated in a socially distant way. There’s also the challenge of refrigeration: both Moderna and Pfizer’s vaccines need to be frozen, while Pfizer’s requires special ultra-cold freezers that many healthcare facilities don’t currently have.


Lack of federal leadership 

The previous administration’s decision not to create a federal distribution plan meant that individual states have had to create their own plans for distribution. There is optimism that distribution will accelerate substantially in the coming month, especially after the new administration quickly released a 200-page strategic plan that aimed to expand partnerships with pharmacies, ramp up vaccine production, and establish thousands of community vaccination sites.


Prioritizing high-risk populations

The Centers for Disease Control and Prevention (CDC) have made specific recommendations for how states should prioritize different populations for COVID-19 vaccination. All states followed the Tier-1 guidance to first prioritize health-care workers and residents of long-term care facilities. As of February 2021, virtually all states have started to vaccinate older adults, though the exact age varies by state. Be sure to check out your state’s vaccine distribution page to learn more about its specific plan.


Slowing down for dose #2

In the early months of distribution the federal government had been holding back doses stemming from a concern that people’s second doses may not arrive fast enough. As of January that has changed, but in many cases distribution centers are still waiting to ensure that the timing of the second doses are well-coordinated. As a result, the pace at which people are receiving first doses has been much slower than desired.


Overwhelmed healthcare workforces

Healthcare workers are obviously well-suited to be the ones to administer the COVID-19 vaccines. But many of them have spent the past year overwhelmed with ICU patients, on top of devoting substantial time to COVID-19 testing and contact-tracing. This has forced distribution sites to improvise and to recruit large numbers of volunteers – and even retirees – to help administer doses of the vaccine.


Expectations versus reality

President Trump made multiple remarks in the fall that may have given many Americans a false sense of the speed of vaccine distribution. In September he said that the vaccine would be ready in October and that there would be “enough vaccines for every American by April.” 

Many experts believe that such ambitious public statements may have led many Americans to assume that the entire country would quickly get vaccinated. With widespread vaccination now seeming unlikely to be achieved by April, the roll-out of the vaccine has inevitably seemed to be even slower than it actually is progressing.

Jennifer Abrams, MD, February 9, 2021