Vaccine rollout is more like a dribble so far. What went wrong?

“The Trump administration’s plan to distribute vaccines is falling behind, far behind,” President-elect Joe Biden said this week.

Back in October, President Trump had promised to deliver “100 million doses of a safe vaccine before the end of the year.” Earlier this month, Secretary of Health and Human Services Alex Azar said, “based on current production schedules, we expect to have enough doses to vaccinate 20 million Americans by the end of this year.”

Well, the end of 2020 is here. As of Dec. 28, 2.1 million Americans had received the first of two doses out of approximately 11.5 million that have been distributed, according to the Centers for Disease Control website. “That number might increase by several [tens of thousands] just because of the delay in information, but certainly nowhere close to 20 million,” says Yahoo News Medical contributor Dr. Kavita Patel. (Gen. Gustave Perna, who is leading Operation Warp Speed, updated the number of doses distributed to over 14 million on Wednesday during a press briefing.)

Biden expressed concern this week that if vaccine distribution “continues to move as it is now, it’s going to take years, not months, to vaccinate the American people.” And Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, now believes the country will need to vaccinate between 80 and 85 percent of Americans — more than 250 million people — to achieve herd immunity, an increase from an earlier estimate of 70 percent.

CNN medical analyst Dr. Leana Wen broke down the numbers of how long this would take at our current rate of vaccination distribution:

So what’s the delay in getting the COVID-19 vaccine into people’s bodies?

Dr. Patel says there are two factors at work: a mismatch between demand and the vaccine allocations given to the states, and confusion stemming from the absence of a uniform policy on who should be inoculated first. “Most of the states got less than they expected,” she said. “I do think that states which are incredibly underfunded, stressed and dealing with their own COVID testing and treatment dilemmas are now being asked to do this incredibly logistically complicated effort to vaccinate people.”

On top of that, Patel says vaccination guidelines vary from state to state. “If you’re in the state of Texas, for example, the next priority population after frontline health care workers in nursing homes is actually people over the age of 16 with chronic conditions.” She says that guidance differs from D.C., for example, where they are following CDC guidelines — so the people next in line to receive the vaccine after health care workers would be frontline, essential workers. “Those differences are confusing because if I drive from one jurisdiction to another, I could have a completely different set of options for vaccination,” Patel says. She proposes that if there were unified, binding national guidance, it would help to clear up this confusion.

Regardless, Patel expects the vaccination rate to pick up dramatically. She believes it’s possible for individual clinics or retail pharmacies to give about 100 COVID-19 vaccinations per day, based on how many flu shots her clinic can administer.

However, Patel says that depends on whether there will be enough vaccine supply from Pfizer and Moderna. “We're going to need other manufacturers to have successful trials and be authorized for us to get to a summer where we have a majority of people vaccinated.”

President-elect Biden pledged that once he’s in office, he plans to invoke the Defense Production Act to boost vaccine production, working toward his goal of administering 100 million doses of the COVID-19 vaccine within his first 100 days in office — speeding up the process from a rate of a million a week to a million a day.

But 100 million is still less than half of what Fauci thinks will be needed to achieve herd immunity.

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