State leaders say Operation Warp Speed overpromised and underdelivered, setting them up to fail in the vaccine rollout

• US state health departments have struggled to deliver coronavirus shots in pace with the timeline put forward by Operation Warp Speed.
• Vaccinating 20 million people by the end of 2020 was never realistic, state health officials said, given a lack of funding and limited vaccine supply.
• Joe Biden will likely attempt to procure additional funding to vaccinate 100 million people in his first 100 days.

Dr. Steven Stack, Kentucky's public-health commissioner, doesn't consider the US vaccine rollout a failure.

The problem, he said, is that "we overpromised and underdelivered as a nation."

"Had we just projected realistic quantities, the public wouldn't have seen this as a shortcoming," Stack added.

Like most state health departments across the country, Kentucky has struggled to deliver shots in pace with the ambitious timeline put forward by Operation Warp Speed, the Trump administration's coronavirus vaccine initiative.

At the start of December, Warp Speed officials estimated that the US could administer 20 million coronavirus shots by the end of 2020. The nation is still nowhere close to reaching that milestone. Just over 9 million Americans have been vaccinated so far, officials said on Tuesday.

Several public-health experts say the program's goal was never realistic, since states were not given additional funding for vaccine distribution heading into the rollout.

"When you're in the midst of an emergency, you really need to have realistic goals," Marissa Levine, a public-health professor at the University of South Florida, told Business Insider. "I knew that whatever the federal government was able to do wasn't going to translate into actual numbers of people who were vaccinated because the planning and the resources to do that planning were not adequate."

In many cases, the healthcare workers and hospital administrators tasked with distributing coronavirus shots so far are also the ones coordinating care or directly treating sick patients during this surge of coronavirus cases. Hundreds of ICUs across the country have reached maximum capacity.

Public-health experts say Operation Warp Speed should have adjusted its timeline to account for these constraints.

'No dedicated funding of any substance or size'

Officials from both the federal government and state health departments have said that a combination of the Christmas holiday and inclement weather slowed down the initial vaccine rollout. But other factors continue to hinder the distribution.

The federal government provided states with a vaccination playbook in September, but deferred to states to come up with their own plans.

"There was no dedicated funding of any substance or size provided for this project," Stack said. "We've been saying that for many months before we got to this point. There was great funding in the innovation and development of these products, great funding in the infrastructure to ship them and get them out, but then there was no funding provided of meaning for administering the vaccine, which is the last mile of this journey."

In late December, Congress passed a coronavirus relief package that gives states about $8.7 billion to help with vaccine distribution issues.

"Obviously that would have been more helpful a few months ago," Stack said, adding that he's not sure whether the relief package will be enough.

A lack of funding has also made it difficult for states to communicate with residents about when and where to get their shots, according to Dr. Rachel Levine, Pennsylvania's health secretary.

"The money for our communication strategy is in this new emergency supplemental bill," she said. "We're looking forward to having access to that funding so that we can roll out the robust communication plan that has been developed for the vaccine."

States face limited vaccine supply and uncertainty about how much they'll get

Some states are still receiving limited quantities of the vaccine. Kentucky's public health department, for instance, receives around 53,000 doses of coronavirus vaccine per week. At that rate, it could take more than a year and a half to vaccinate all of the state's 4.5 million residents.

"We've been told that we'll get that quantity most likely for the next couple of months ahead, and it's unlikely it will increase significantly in the near future," Stack said. "It's better than nothing, but it's also much less than the demand."

That limited supply, he added, means the state can only offer vaccine at a small number of high-volume locations.

"There's so little of it, that if you sprinkle it like pixie dust all over the state, then if every site only got five doses a week, nobody ever knows when a site may or may not have vaccine," Stack said.

Some state officials have also said they often don't know exactly how many doses they'll get each week.

"We end up knowing a week or two in advance what the possibility is of how much vaccine we'll get, but then the actual amount that is going to be transported often ends up being somewhat different," Rachel Levine said of Pennsylvania's supply.

The expectations that states can deliver every dose right away, she added, "have been too high."

Trump and Warp Speed Officials blame states

President Donald Trump and some Operation Warp Speed officials have placed the blame on states for the slow vaccine rollout.

"We see governors who are leaving vaccines sitting in freezers rather than getting it out into people's arms," Alex Azar, Secretary of the Department of Health and Human Services, said on a press call last week. During another call on Tuesday, he added that "state restrictions on eligibility have obstructed speed and accessibility of administration."

To address that latter concern, Warp Speed officials have encouraged states to speed up their vaccine rollouts by vaccinating several priority groups in tandem. The CDC has recommended vaccinating healthcare workers and nursing home residents first, but in situations where supply exceeds demand or doses might expire, federal officials are urging states to distribute doses to elderly Americans.

Azar has also pushed states to begin deploying vaccines at pharmacies, community health centers, and mass vaccination sites. The federal government has partnered with pharmacy chains like CVS, Walgreens, and Walmart to assist with this wider vaccine rollout.

"States have ample funding, including $3 billion more on the way, to support such efforts," Azar said on Tuesday, referring to the first installment of federal relief money. That's set to be delivered to states by January 19.

Getting back on track

On Tuesday, Warp Speed officials announced that instead of holding back half the vaccine supply to guarantee that every person who gets a first shot has a second waiting, they will begin distributing as many doses as possible to Americans over 65.

"We had always planned to move to a more advanced phase of how we manage this once we had confidence in our supply chains," Azar said of the change.

President-elect Joe Biden had already pledged last week to release all available vaccine doses when he takes office. He has also set a goal to vaccinate 100 million people in his first 100 days after taking office on January 20 - a rate of 1 million immunizations per day. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has said that goal is still within reach.

As of Tuesday, the US had achieved a pace of around 700,000 vaccinations per day.

"I am absolutely confident that, as the month of January unfolds, the pace of immunization will rapidly increase, delivery systems will mature, IT systems will be modified to support the operation, and we'll find ways to make more clear to people who want to be vaccinated who has vaccine and how they can access it," Stack said.

Biden's coronavirus response team has also called for more money from Congress to hit its vaccination target. Jeff Zients, who Biden tapped to coordinate his pandemic response, told The Washington Post that the most recent coronavirus relief package was merely a "down payment."

Biden has also promised to lean more heavily on the Defense Production Act, which allows him to require businesses to prioritize the federal government's supply-chain needs. This could help fast-track the distribution of vaccine supplies.

"I think brighter days are ahead," Stack said, "but we do need the public to please not take their eye off the ball on the importance of wearing their masks and maintaining social distancing so that we can keep ourselves safe until we can get enough people vaccinated."