With only a few days to go, the United States will likely fall short of its goal to vaccinate 20 million Americans by the year's end as the nation embarks on what will be a historic campaign to inoculate hundreds of millions of people against the coronavirus by the middle of next year.
Two Covid-19 vaccines from Pfizer-BioNTech and Moderna have now been given emergency authorization from the Food and Drug Administration, paving the way for the first handful of front-line health-care workers and vulnerable long-term care residents to be inoculated against the virus.
The Trump administration's vaccine program, Operation Warp Speed, planned to provide 40 million doses of vaccines between the two companies by the end of the year, which would've been enough for roughly 20 million people since each drug requires two shots at differing intervals.
As of the latest figures released Monday, however, it seemed far short of that goal: The Centers for Disease Control and Prevention said just more than 11.4 million doses had been distributed since Dec. 13 but only about 2.1 million had been administered. The CDC noted a number of reasons for the considerable difference between the number of distributed doses that have yet to be administered.
Part of the problem is a lag in data reporting, the agency said, while other issues lie with how jurisdictions are managing their allocations. The launch of the federal government's partnership with major pharmacy chains like CVS and Walgreens, which will be tasked with vaccinating long-term care residents, is still pending, the CDC said.
But even if there's undercounting, the United States is still "below where we want to be," White House coronavirus advisor Dr. Anthony Fauci told CNN's "New Day" on Tuesday.
"I believe that as we get into January, we are going to see an increase in the momentum," Fauci said, adding that he hopes that push will be enough to "catch up to the projected pace that we had spoken about a month or two ago."
Nonetheless, only a few months ago the federal government's prediction for how many doses would be available was much higher than its eventual 40 million threshold. In October, Health and Human Services Secretary Alex Azar said during a keynote speech at a virtual event hosted by Goldman Sachs that there could be as many as 100 million doses available.
There have also been noticeable hurdles along the way. President Donald Trump's Covid-19 vaccine czar, Moncef Slaoui, acknowledged to reporters last week that the 20 million goal was "unlikely to be met" and the ramp-up of immunizations "is slower than we thought it would be."
U.S. Army Gen. Gustave Perna, who oversees logistics for Operation Warp Speed, repeatedly apologized shortly following the initial distribution of Pfizer's vaccine after some state officials reported their allocations of doses were cut, and it wasn't made clear who was at fault.
"The mistake I made is not understanding with exactness — again my responsibility — on all the steps that have to occur to make sure the vaccine is releasable," Perna said at a press briefing Dec. 20.
Pfizer explained in a statement to CNBC that each lot of its vaccines must receive "certificates of analysis" at least 48 hours prior to distribution under the company's emergency use authorization with the FDA. While it wasn't made clear whether the certificates were the reason for the discrepancy between the numbers Perna originally gave the states, those estimations were cut since the doses weren't available for release.
"These doses are being distributed at states' direction to the American people as quickly as they are available and releasable, and the rapid availability and distribution of so many doses – with 20 million first doses allocated for distribution just 18 days after the first vaccine was granted emergency use authorization – is a testament to the success of Operation Warp Speed," said Michael Pratt, a spokesman for the vaccination program, in a statement Tuesday.
Pratt said there should be 20 million doses of vaccines allocated to the jurisdictions by the end of December and distribution will span into the first week of January. The second doses will then be distributed a few weeks later.
"We were too ambitious in our initial rollout," Dr. Leana Wen, former Baltimore health commissioner, said Tuesday. "Here's what happened. Here's what we're going to do to fix it. That's what we should be hearing."
The slower-than-expected initial rollout is even more concerning this early on because "this was supposed to be the easy part," Wen said.
Because doses of the authorized vaccines are so scarce, the federal government encouraged states to begin with vaccinating only health-care workers and long-term care residents, which means that hospitals and pharmacies that have partnered with long-term care facilities are responsible for the administration of shots.
When the government opens up eligibility to receive the shot to a broader portion of the population, vaccine doses will need to be administered outside of hospitals and nursing homes, which could create more challenges, said Wen, an emergency physician and public health professor at George Washington University.
"When we talk about actually people in the community coming to locations like pharmacies, doctor's offices ... that's the hard part," Wen said in a phone interview.
State and local officials anticipated some early hiccups, which is, in part, why the government decided to start with health-care workers, Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, said in a phone interview Tuesday.
"There are kinks that have to get worked out and this was probably a good population to work them out with," he said, adding that preparation was a rapid process. "It's just been a rapid speed preparation for this launch and states and locals getting a lot of needed information at the last minute."
Up until now, however, Plescia added that he has not heard of any "major snafus," and he expects the pace of vaccinations to really pick up in January. He said he believes the true number of doses administered is also "substantially higher" than the count published by the CDC.
That's because the CDC is likely relying on state vaccine registries, which are far outdated, Plescia said. The quality of state registries varies across the country, but "even the best ones, I wouldn't really call them 21st century IT systems," he said. The Christmas and New Year's holidays are both probably impacting the ability of hospitals to vaccinate their employees, too.
"We are in the middle of one of the biggest national holidays of the year and everybody's had a pretty rough year, so I think people really are taking some time off," he said. "That's certainly going to slow down the demand."
For instance, Riverside Health System in Virginia began vaccinating its front-line health-care workers on Dec. 16, but decided to limit the number of appointments in the first few days, Riverside's chief pharmacy officer, Cindy Williams, previously told CNBC in a phone interview. That would allow the health system to determine how much demand there would be and to get a feel for how its strategy would work, she said.
"What we found is that we were much more efficient than we thought we were going to be," Williams said, adding that Riverside Health was eventually able to triple the number of appointments given in a period of time in some cases. Williams said it wouldn't hold any appointments on Christmas Eve and Christmas Day and planned to restart vaccinations on Monday.
"We're ramping things up pretty rapidly, and we're also finding that team members have been very willing to step up and sign up for the clinics," Williams said.
States and local jurisdictions did receive some welcomed news this week after Trump signed the coronavirus relief and government funding package into law on Sunday: $8.75 billion in additional funding for their vaccine distribution programs.
The money, which is in line with what national organizations had called for, would help pay for additional personnel for vaccination clinics, adequate resources to safely store doses at ultra-low temperatures, needles and other critical supplies, and an enhanced communications effort to persuade people of the drugs' safety, among other costs.
The funding has been a long time coming. For months, state and local health departments have been calling on Congress to provide more than $8 billion in additional funds to carry out their vaccine distribution plans, which were completed and submitted to the CDC in October.
"This money is late," said Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials.
"This is something that should have been done in the spring and in the summer so that folks could do some of the buildup before the vaccines were available. Now they're trying to do the build up while vaccines are available," Casalotti said in a phone interview Thursday.