The vaccine rollout is not going as planned. Since mid-December, the U.S. has distributed 21.4 million doses of COVID-19 vaccines; fewer than one-third have actually made it into people’s arms. The problems have been many and varied: holiday delays, scheduling scams, long lines in some places, and not enough demand in others. These initial kinks are getting worked out, but that alone will not get us back to normal anytime soon. The next phase of the vaccine campaign—reaching tens of millions of elderly people and essential workers, along with the rest of the community—will be even harder.
The initial vaccine rollout is simpler than the phases to come because it targets hospitals and long-term-care facilities, where the relatively small number of eligible people are already concentrated. Finding and scheduling them should be straightforward. “This is the easy part,” says Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. Finding and scheduling people in the next priority groups will bring a new tangle of logistics, for which the country is still not prepared.
In the coming months, state and local health departments will have to stand up mass-vaccination clinics that can handle hundreds or even thousands of people a day in the middle of a pandemic, when crowds are dangerous. Thousands of doctors’ offices and pharmacies across the country will also need to learn how to handle and administer unusually fragile vaccines. And eventually, as the pool of people eager to get a vaccine is exhausted, public-health officials will need to persuade the uninterested, the reluctant, and even the skeptical to get vaccinated, so that communities can reach the 70 to 90 percent necessary for herd immunity. The hardest work still lies ahead.