It seemed like the vaccine would take up to a year to arrive.
Back in January, even though two COVID-19 mRNA vaccines had been authorized for emergency use and were being distributed, forecasts of when the shots would be available to the general public stretched deep into autumn 2021.
Distribution was slow, and that period — the final weeks of the Trump administration — left a pall hanging over the vaccine distribution effort.
Since then, however, the operation has turned around. What started off at hundreds of thousands of doses per day has steadily increased to more than two million per day.
New funding for state distribution, an increased federal presence in the distribution process under the Biden administration, and time to iron out kinks that appeared at the local level have all allowed the pace of vaccinations to go from a few hundred thousand a day up to 2.4 million a day.
“I don’t really know what the Trump administration had in mind or what they were planning as far as the vaccine, we only know what they said, which wasn’t a comprehensive vision,” Claire Hannan, head of the Association of Immunization Managers, told TPM.
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Experts described money as the biggest problem early in the vaccination campaign and the area in which actions by Congress and the Biden administration made the biggest difference in upping the speed at which Americans are vaccinated.
That problem stretched from the federal level on down to the local, with national associations representing vaccinators and public health departments demanding throughout 2020 that Congress appropriate money for the effort as local public health officials, like Guilford County, North Carolina’s Iulia Vann, tried to budget their way forward without being certain how much money would come.
“It’s disheartening to see that we don’t have that support to do our work without having to worry,” Vann told TPM in December.
Congress passed $8 billion in funding for vaccine distribution in the last days of December, and appropriated an additional $7.5 billion in the American Rescue Plan.
Part of the money has gone toward remedying long-standing problems like nursing and vaccinator shortages, allowing states and cities to scoop up and train people to do the inoculating.
More than enrolling private providers
But the Biden administration has also added capacity through national guard deployments and FEMA sites.
It’s a marked difference from the Trump administration’s strategy which, Hannan told TPM, focused on “enrolling private providers and that’s clearly not enough when you’re trying to vaccinate millions of people a day.”
The Biden administration has also ordered FEMA to reimburse states for 100 percent of COVID-19 and vaccine-related costs, an increase from the Trump administration rate of 75 percent. That’s given local officials more freedom to expand vaccination sites to the general public as criteria for who is eligible to get the shot expands.
The money, combined with the increased federal presence in the vaccine rollout, has made a difference at the local level.
New York City, for example, went from vaccinating around 9,000 people per day in December to running the country’s best-performing vaccination site at the Javits Center, which in March led the country three days in a row at 14,000 shots administered per day.
Other problems boiled down to unexpected refusals among nursing home staff and other medical workers to receive the vaccine, which complicated plans that initially expected that everyone would agree to get the shot. That came on top of pre-existing communication problems between government agencies responsible for moving the shot down to the local level.
“There was an issue with coordination between state, private and federal partners and in getting those vaccination programs running, more could have been done to get that ball rolling,” Josh Michaud, an epidemiologist at Kaiser Family Foundations, told TPM. “But the other group that was targeting for vaccinations was health care workers, and a lot of states had significant issues in vaccinating that population, without intervention on the private side.”
Early vaccination efforts were also plagued by kinks at the local level, part of which had to do with bureaucratic hiccups in registering vaccinators and which also had to do with managing the complicated logistics of taking the shots and delivering them.
“A lot of it was just working out the kinks,” Michaud added.
Another piece has to do with the phase of distribution that brings vaccine from the manufacturer’s warehouse on to the states.
This is the part of distribution — from pharmaceutical companies to the states — for which the Trump administration loudly look credit, and which began to experience serious problems in the first weeks of the rollout.
Emblematic of this was a mid-December mini-scandal over a decision by the Trump administration to cut state vaccine allocations by up to 50 percent in some cases. Though the reasons for this were complex, part of the confusion was due to a belief by the states that vaccine allocations provided by the Trump administration were final.
In fact, Trump officials said in December, states would only get final allocations the day before — adding on a huge logistical challenge to an already difficult situation.
The Biden administration has not completely solved that problem, but has significantly diminished it by agreeing to provide states with a minimum vaccine allocation three weeks before delivery.
“They’re really proactively giving states a floor three weeks out, but they’re not able to give them solid looks into upcoming weeks,” Hannan said.
She went on to say that though the pace had improved drastically, it’s a massively complex system.
“It’s much more complicated than it looks,” she added.