5 Reasons the U.S. COVID-19 Vaccine Rollout Is Behind Schedule

A week into 2021, COVID-19 vaccine rollout in the U.S. is behind the goal set forth by the Trump administration’s Operation Warp Speed. The initial plan was to have enough doses available to vaccinate 20 million people before the first of the year, a number the U.S. has currently fallen short of. But experts say they aren’t surprised by the lag. 

“I’m not even sure I’d say we’re behind,” Rebecca Wurtz, MD, MPH, associate professor in the School of Public Health at the University of Minnesota, tells Verywell. “We’re behind an empty federal promise of 20 million that was completely made up on the spot. It was an election-year promise, not a logistical supply-chain promise.”

COVID-19 Vaccine Numbers

Operation Warp Speed (OWS) is the Trump administration’s accelerated initiative “to produce and deliver 300 million doses of safe and effective vaccines” for COVID-19.

In a White House briefing on November 13, President Trump said, “We plan to have enough vaccine doses available for use in the U.S. population to immunize about 20 million individuals in the month of December." And on December 3, OWS officials indicated they were on track with this goal.

But the Centers for Disease Control and Prevention (CDC) vaccine dashboard shows that as of January 8, only 5.9 million people in the U.S., including those at long-term care facilities, have actually received their first dose of a COVID-19 vaccine. The CDC notes that the dashboard may have a lag in data as a result of healthcare agency delays in reporting.

The currently authorized COVID-19 vaccines—Pfizer-BioNTech and the Moderna vaccines—require two doses per person given a few weeks apart. OWS says it holds a portion of the initial U.S. vaccine supply in a “safety stock” to be shipped in time for people who received the first dose to get their second dose. On January 5, OWS released a statement that 19.1 million vaccine doses have been distributed over the last 21 days. 

But experts say that number doesn’t equate to jabs in arms. “If vaccination efforts continue at this pace, it will take more than three years for 70% of Americans—a target for herd immunity—to receive the first dose,” Andrew Peterson, PhD, assistant professor in the Institute for Philosophy and Public Policy at George Mason University College of Humanities and Social Sciences, tells Verywell. “But the vaccines in use require two doses, so the timeline is likely far worse.” 

“I tend to look at glasses half full rather than half empty,” William Lang, MD, medical director of JobsiteCare and WorldClinic, tells Verywell. “But in this case, it would be hard for anyone to say that we are where we expected to be or where we need to be.”

Wurtz, on the other hand, says she thinks vaccine rollout is going “okay,” considering the challenges faced at the end of the year. She also expects the pace will improve quickly in the coming weeks. 

Why Is There a Lag?

As the rate of vaccination falls behind initial goals, experts weigh in on what is potentially causing the lag.

The Impact of the Holiday Season

Public health officials and healthcare workers have worked around the clock despite the holidays, Wurtz says, but the holiday season coinciding with initial vaccine distribution definitely created a lag. “There’s been very little real-time in which to actually make it roll out,” she explains.

Lang agrees. “This major lift coming just as the holidays were kicking off certainly has played a big role,” he says. “The surgeon general specifically admitted this was an issue.”

The Food and Drug Administration (FDA) issued emergency use authorizations for both Pfizer and Moderna in December, with the first doses of the Pfizer COVID-19 vaccine administered on December 14. On December 27, Congress passed the Consolidated Appropriations Act, 2021, or what is also known as the COVID-19 relief bill, which provides funding to states for vaccine rollout.

“We've assigned this job to public health and the healthcare systems, which have been all-out sprinting since March,” Wurtz says. “And we haven’t given them any other resources until a week ago Sunday.”

Shipping and Storage Logistics

The holiday season also places a strain on contracted shipping companies, which are responsible for what’s called “the last mile” of vaccine shipment. “The organizations that are actually physically distributing the vaccine are UPS and FedEx, who were delivering all of our holiday packages,” Wurtz says. 

She explains that vaccine doses typically arrive to a centralized distribution location before going on to individual destinations via contracted shipping companies, which are generally overtaxed before the holidays—and afterward, with returns.

Plus, health departments are still working out shipping and storage logistics along with any discovered glitches. “I would give the system a little bit of a pass,” Lang says. “We’ve just joined the battle campaign to immunize, so now plans are meeting reality, and reality is different than tabletop exercises.”

Swamped Healthcare System

Meanwhile, healthcare systems around the country are swamped with COVID-19 patients. More than 132,000 people in the U.S. are currently hospitalized with the virus.  And healthcare workers are often the ones who administer a vaccine.

“In places like California, where the healthcare systems are already working way beyond their capacity there aren’t a lot of extra personnel there sitting on their hands," Wurtz says. "Systems are stressed, and we have to cut them a little bit of slack.”

Plus, frontline workers, who are designated to receive the vaccine first, may just not have had the chance to get vaccinated yet. “[They] can barely get away from their clinical duties to get time to stand in line to get the vaccine,” she adds. “Even if it’s done in a very prompt way at their workplace, it’s still taking them away from under-resourced, understaffed clinical settings.”

Hiccups at the State Level

The initial benchmark set forth by Trump’s OWS plan doesn’t account for all the details down the line, Wurtz says. “I know the federal government promised 20 million doses by the end of the year,” she says. “But they’re not responsible for actually putting it into people’s arms. State and local health departments and local healthcare organizations are responsible for putting it into people’s arms.”

Rollout plans and logistics vary by state and community, and that can lead to confusion for residents. “Unfortunately, I think there’s been relatively poor communication,” she says. “States are still kind of grappling with how to message this in terms of when your chance will be…what are the actual places where you can go.” 

Lang says documentation of who has received the vaccine has been another factor potentially leading to a lag. “Brand new huge computer systems—CDC’s Vaccine Administration Management System—are being brought online without any shakedown period,” he explains. “It’s taking time for everyone to figure this out.”

Reserves Creating Bottlenecks

Another consideration is whether states or local public health officials are holding vaccines in reserve to provide the second dose, even though OWS has said it will be distributing those second doses as they are due.

“I think there’s just a lack of trust,” Wurtz says. “And so people are afraid to deliver 100% of the doses they have on hand for fear that three weeks from now, we won’t see the next round of deliveries from the federal government. I understand that distrust. I think that the federal government has to prove itself.”

For example, according to the Associated Press, which conducted a review of each state’s COVID-19 vaccine rollout, Tennessee has been creating a reserve in case of spoilage.

Waiting for a Vaccine

Wurtz urges to be patient with vaccine rollout. “Has it been rocky? Yes,” she says. “Is it hard to deliver hundreds of millions of doses of vaccine? Yes. Is it going to happen? Yes. Is it going to happen as fast as we would like? No. For all those reasons, I wish that people would take a deep breath.” 

In the meantime, she adds that we shouldn’t let our guard down against COVID-19, and we should continue to wear masks and maintain social distance in public, and stay home whenever possible. “It’s not as though just because the vaccine exists we can all go out and party now,” she says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.