Washington, DC – In the last 10 months of desperation and hardship caused by the COVID-19 pandemic in the US, the prospect of an effective vaccine has always been seen as the light at the end of the tunnel.

That hope appeared to be fulfilled last month when US health officials approved two emergency vaccines across the country.

But weeks after the U.S. Food and Drug Administration (FDA) approved Pfizer-BioNTech and Moderna vaccines, public health experts say vaccination efforts have been slow and haphazard.

“The introduction of the vaccine has been slower than expected, but frankly, messy too,” said Kevin Schulman, a professor at Stanford University School of Medicine in California.

Schulman, who serves as the director of industry partnerships and education for the Clinical Excellence Research Center at Stanford, recently released a paper highlighting the need for an effective public awareness campaign to promote the vaccine.

A man works at a “vaccination superstation” built in San Diego, California in January to vaccinate 5,000 people against COVID-19 every day [Mike Blake/Reuters]To date, there has been no national effort to address misinformation and address immunization concerns. A recent Gallup poll found that only 65 percent of Americans are willing to take the vaccine, and acceptance among the non-white population has dropped to 62 percent.

However, this is just one of many challenges faced by vaccination efforts.

In the absence of centralized planning, clear federal guidelines, databases of who should be vaccinated first, and the infrastructure necessary for mass vaccination, the US is falling far short of the targets it set for the first few weeks of vaccination.

Missed goal

Government officials had said they hoped to vaccinate 20 million people by the end of 2020. By Jan. 15, just over 12.2 million people had received their first dose of the two-shot vaccine (CDC), according to the U.S. Centers for Disease Control and Prevention.

The CDC did not return Al Jazeera’s request for comment on the introduction of the vaccine.

In an interview with NBC News on Friday, US Secretary of Health Alex Azar, who resigned a day later over President Donald Trump’s handling of the Capitol riot, appeared to blame states for the slow delivery of the vaccine.

“We have had tremendous success with these incredibly powerful vaccines – 38 million vaccine doses are available, 31 million have already been shipped and distributed. We have more than 12 million rounds of guns, ”said Azar.

“We have had some governors who have been too strict and restrictive on the groups of people they want to offer vaccines to.”

The now-former HSS secretary said the federal government has urged governors to give the vaccine to anyone over 65 and those with pre-existing conditions in order to “protect the vulnerable”.

However, in the same interview, Azar confirmed reports that there were no reserve supplies of second doses of the vaccine, contradicting previous statements that the second shots are in reserve.

He is confident that “ongoing production” can “deliver the second dose for people”. The HHS department did not respond to Al Jazeera’s request for comment over the weekend.

However, Schulman lamented a lack of planning in the months leading up to FDA approval.

“That’s all that should have been worked out months ago – about how we develop lists, how people are prioritized for the vaccine, and then how we physically set up vaccination clinics,” he told Al Jazeera.

“These talks are ongoing now, but they could have lasted months.”

Theresa Ogunjimi, a registered nurse, rests for a moment in a COVID-19 unit at the United Memorial Medical Center in Houston, Texas on December 12th [File: Callaghan O’Hare/Reuters]

Biden’s plan

US President-elect Joe Biden, inaugurated Jan. 20, called the vaccine launch a “bleak failure so far” and promised to launch a rapid vaccination campaign that would deliver 100 million shots in the government for the first 100 days Office.

“Our plan is as clear as it is bold: get more people vaccinated for free, create more places to get vaccinated, mobilize more medical teams to get the shots in people’s arms, increase the supply and bring it up Get it out the door as quickly as possible, ”Biden said in a speech on Friday.

Mouhanad Hammami, chief health strategist in Michigan’s Wayne County, home of the city of Detroit, said he was “very optimistic” about Biden’s plan – and specifically the promise to make vaccines more readily available.

“There are plans to increase the supply to states and eventually to us and other health systems and not withhold these vaccines, which will help tremendously,” Hammami told Al Jazeera.

“I hope that funding will also be considered to increase capacity. With more vaccines, you will need more people to vaccinate. You need a system that can cope with this increase in supply. “

President-elect Joe Biden will receive his second dose of the coronavirus vaccine at ChristianaCare Christiana Hospital in Newark, Delaware on Monday, January 11, 2021 [File: Susan Walsh/AP Photo]Hammami said he expected approval of other vaccines, including the Oxford-AstraZeneca shot, which the UK approved in late December, would help address the supply issue.

The federal government initially gave the impression that it had millions of vaccine doses in reserve. However, Azar’s confirmation on Friday that stocks have run out confirms the supply is becoming an issue.

The US had ordered a total of 400 million doses of Pfizer-BioNTech and Moderna vaccines by the end of 2020 – enough to vaccinate 200 million of a population of 328 million. However, the schedule for dispensing the cans is unclear.

In May 2020, the US government also pre-ordered 300 million doses of the Oxford-AstraZeneca vaccine, which is still pending approval.

$ 20 billion for vaccine distribution

On Friday, Biden said he would allocate $ 20 billion of his $ 1.9 trillion COVID-19 aid package to the vaccine distribution plan.

The funds would help set up federal government-sponsored vaccination centers and mobile clinics, and help states and local health systems deliver the vaccine – logistical support required to administer one million vaccines every day.

People line up at a 24-hour vaccination center at the Brooklyn Army Terminal in Brooklyn, New York on Jan. 11 to receive a dose of the COVID-19 vaccine [File: Brendan McDermid/Reuters]“Knowing that not all states and jurisdictions have the resources to scale vaccinations at the pace required by this crisis, the Biden Harris administration will use federal resources and emergency services to set up new vaccination sites and the Expand state and local efforts across the country. “The Biden transition team said in a statement on Friday.

The Infectious Diseases Society of America (IDSA), a Washington-based health professional specializing in infectious diseases, spoke in favor of Biden’s call for increased funding for the vaccination effort.

“The in-depth management proposal comes at a crucial time and we recommend further broad measures to achieve its goals,” the group said in a statement. “To ensure access to vaccines for the most vulnerable, expansion needs to be rapid with adequate resources and capacity.”

Congressman Frank Pallone, chairman of the House’s Energy and Trade Committee, which oversees public health, also praised Biden’s plan to provide “additional resources and support” to fight the virus, “including the life-saving distribution of vaccines.”

“These investments will protect the health of the American people and help us destroy this virus so we can rebuild our economy,” Pallone said in a statement.

Priority levels

Michigan’s Wayne County was one of the hardest hit parts of the country. The virus killed nearly 4,000 people with a population of 1.7 million.

Hammami said the unprecedented scale of the vaccination campaign has forced health professionals and authorities to address challenges along the way. “It’s like building the plane while we’re trying to fly it,” he said.

According to Hammami, the two main local challenges are getting vaccines available and figuring out how to move from one priority group to another in order to vaccinate as many people as possible.

The county had administered more than 40,000 doses by mid-January, and Michigan Governor Gretchen Whitmer is seeking permission from federal officials to purchase 100,000 doses of the Pfizer vaccine direct from the manufacturer to address a “two-week delay” in supply.

The CDC has recommended vaccinating people gradually based on their occupation, age, and health status. In the first phase, vaccines were given to health care workers that are easily identified, located and accessible through the health facilities they work for.

However, as many states and counties move into the second phase – people over 65 and key frontline workers – they have difficulty building databases of people who should be vaccinated now.

Hammami added that reluctance to take the vaccine makes planning efforts difficult because it is not always clear how many people within a given vaccine priority group are actually ready to receive the vaccine.

Dr. Anthony Fauci, director of the National Institute on Allergies and Infectious Diseases who recommends the Biden transition, has called for a relaxation of priority group compliance to ensure vaccines are administered and no longer stored.

“When you have a dose, give it and don’t be as rigid as those early labels,” Fauci told NBC’s Today Show on Friday.

Fauci added in a separate interview on Sunday that Biden’s promise to give 100 million doses of vaccine in his first 100 days in office was “perfectly feasible.”

Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases, gestures after receiving his first dose of the COVID-19 vaccine on December 22, 2020 [File: Patrick Semansky/AP Photo]

Greater awareness

Stanford-based Schulman said another problem is that private and public health systems “don’t necessarily get synchronized” – but it is too late to put in place a public infrastructure for vaccine delivery.

Instead, he called for existing networks to be strengthened with more funding and logistical support.

Ultimately, if the US is to get the pandemic under control, vaccines must be available, and health officials must develop awareness campaigns to encourage people to get the shots.

“The two tragedies would be to get people to come in because we believe we will have the vaccine available and we don’t have it because we didn’t get our shipments,” Schulman said.

“And the worst tragedy would be to find out that we have the vaccine available so we can give it, but we don’t have enough people to vaccinate.”

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