A significant delay in coronavirus vaccinations is putting pressure on public-health leaders to explain the slow progress while hospitalizations continue to set records as the nation heads into the new year.
Although officials projected that the United States would be able to vaccinate 20 million people by the end of December, the Centers for Disease Control and Prevention reports that 11.4 million doses have been sent to states and only about 2.1 million people have received the vaccine's first dose with three days until the month's end.
Gustave Perna, who oversees vaccine distribution for the Trump administration's Operation Warp Speed, apologized earlier this month for a "miscommunication" that caused states to receive fewer doses of the Pfizer-BioNTech vaccine than they had expected.
President-elect Joe Biden criticized the Trump administration Tuesday for the pace of distributing covid-19 vaccines and predicted that "things will get worse before they get better" when it comes to the pandemic.
"We need to be honest -- the next few weeks and months are going to be very tough, very tough for our nation. Maybe the toughest during this entire pandemic," Biden said during remarks in Wilmington, Del.
Biden encouraged Americans to "steel our spines" for challenges to come and predicted that "things are going to get worse before they get better."
He also went after the Trump administration over its vaccination efforts, warning that the project, dubbed Operation Warp Speed, is moving at a slower pace than needed.
"As I long feared and warned the effort to distribute and administer the vaccine is not progressing as it should," he said.
At the current pace, Biden said, "it's gonna take years, not months, to vaccinate the American people."
President Donald Trump deflected Biden's critique. "It is up to the States to distribute the vaccines once brought to the designated areas by the Federal Government," he tweeted Tuesday. "We have not only developed the vaccines, including putting up money to move the process along quickly, but gotten them to the states."
Biden, who takes office Jan. 20, said he has directed his team to prepare a "much more aggressive effort, with more federal involvement and leadership, to get things back on track."
The president-elect said he would "move heaven and earth to get us going in the right direction."
He set a goal of administering 100 million shots of the vaccine within his first 100 days in office, but said to accomplish that, the pace of vaccinations would have to increase five to six times to 1 million shots a day. Even with that pace, however, Biden acknowledged it "will still take months to have the majority of Americans vaccinated."
FAUCI HOPEFUL
Questioned Tuesday about the pace of vaccinations, Anthony Fauci, the nation's top infectious-diseases expert, acknowledged the lag and said he was cautiously optimistic that vaccinations would pick up momentum to reach previously projected levels.
"Not being responsible myself for the rollout, I can't personally guarantee that we're going to catch up. I hope we do," Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN. "The people who are responsible for it are really on it. The question is, are they going to be able to get back to the pace that we set early on."
Despite the vaccines' slow rollout, Vice President-elect Kamala Harris on Tuesday became the latest high-profile politician to receive a first dose, after Biden and Vice President Mike Pence earlier this month. Scores of government leaders have been among the first to be inoculated in what they frame as an effort to build trust in the vaccines, as many health care workers waiting for their own doses express frustration.
While health officials face criticism for the pace of vaccinations, coronavirus-related hospitalizations are hovering around 118,000, the highest seven-day average since the virus was first reported in the United States in January. New cases are currently averaging around 200,000 per day, while the deaths continue to spike, having reached a record 3,406 -- higher than the number of fatalities in the Sept. 11 attacks -- on Dec. 17.
Officials have expressed concern that holiday travel could fuel an even greater surge of infections, straining the capacities of already struggling health care systems. In his CNN interview, Fauci urged people who have recently traveled to avoid gathering with people outside their households.
"That's what we're concerned about -- that in addition to the surge, we're going to have an increase superimposed on that surge, which could make January even worse than December," Fauci said.
The nation's "out of control" level of infections, he added, makes it difficult for local health officials to effectively trace the contacts of infected people and isolate those who have the virus. The CDC has implored Americans to stay home on New Year's Eve, usually one of the most popular days of the year to gather at bars, and celebrate only with their households or virtually with family and friends.
The ambiguity around the pace of vaccinations leaves open the question of when cases, deaths and hospitalizations will begin to noticeably decline. Gabor Kelen, an emergency-medicine professor at Johns Hopkins University, told Bloomberg News on Monday that he expected "serious relief" would come at the end of March, while former Food and Drug Administration commissioner Scott Gottlieb predicted cases would sharply decrease in the spring, leading to a "quiet" spring and summer.
For now, Gottlieb said the pandemic's U.S. hot spots are the coastal states of California, Massachusetts, New Jersey, New York and Florida. Infections in those states appear to have peaked and, in some cases, begun to decline.
"States that were later to get hard hit are still going to have to go through some level of increased spread before they start to see their peak," Gottlieb said Tuesday on CNBC's "Squawk Box."
DIFFERENT PRIORITIES
Meanwhile, Texas, Florida and some other Republican-led states are bucking federal advice to provide early doses of the new coronavirus vaccine to front-line workers, choosing instead to prioritize older people -- a disconnect already exposing fissures in the nationwide immunization campaign.
Federal recommendations emphasized providing vaccines to grocery store employees, transit workers and other front-line workers, along with people 75 and older. But officials in Florida and Texas, where a combined 50 million people live, are moving ahead with a different strategy: offering vaccine to a broader segment of their elderly populations and asking front-line workers to wait.
The choices reflect distinct needs in a highly diverse country where the coronavirus has killed unevenly, but they also highlight an emerging patchwork that could pose obstacles to the national effort to corral the pandemic. The divergence is coming into view as states face delays in the administration of vaccine doses, with each operating on its own timeline based on the capacities of local health departments and hospital systems.
"We are not going to put young, healthy workers ahead of our elderly, vulnerable population," Florida Gov. Ron DeSantis, a Republican, vowed last week in an address at The Villages, the nation's largest retirement community. A top infectious-diseases official in Texas, Imelda Garcia, said focusing on adults 65 and older and people with chronic conditions "will protect the most vulnerable populations." In Ohio, Republican Gov. Mike DeWine is adopting a similar approach but also including school employees in the early phase, emphasizing the need to return to in-person learning.
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Medical workers and residents and employees at long-term care facilities constitute the first tier in virtually every instance, in line with guidance released in early December by the panel advising the Centers for Disease Control and Prevention.
The expert panel of federal advisers met again before Christmas, seeking to balance protecting workers whose jobs put them in harm's way with shielding those most likely to suffer complications from the virus or die of covid-19. The panel recommended putting people 75 and older and essential front-line workers in the next priority group.
Among those workers -- who the Advisory Committee on Immunization Practices said were most critical to the functioning of society -- are emergency workers, educators, manufacturing workers, corrections officers and transit workers Many could get access to the vaccine early in the new year, though timelines may differ considerably by state.
"It's not ideal to have differences across the states, but in terms of getting the vaccine out and into arms as quickly as possible, it may not be such a bad thing," said Claire Hannan, executive director of the Association of Immunization Managers. As long as states are putting vaccine doses into arms, they are on their way to meeting the ultimate goal, she said.
Separately, Colorado officials on Tuesday reported the first known case in the United States of a person infected with the coronavirus variant that has been circulating rapidly across much of the United Kingdom and has led to a lockdown of much of southern England.
Scientists believe the variant is more transmissible but does not make people sicker.
Researchers have now detected the more transmissible variant in at least 17 countries outside the United Kingdom, including as far away as Australia and South Korea, as of Tuesday afternoon. Officials in Canada had said they had identified two cases.
Also Tuesday, California extended its strict stay-at-home orders in areas where intensive-care units are running out of beds, coming after Gov. Gavin Newsom warned residents to brace for the effect of a "surge on top of a surge" of coronavirus cases from holiday travel.
The state's top health official, Dr. Mark Ghaly, said that Southern California and the agricultural San Joaquin Valley still have what is considered no ICU capacity and that the state's restrictions would continue longer there.
Newsom said Monday that even with hospital admissions plateauing in some places, the state was destined to move into a "new phase" that it's been preparing for as it sets up hospital beds in arenas, schools and tents, though it is struggling to staff them.
"As we move into this new phase, where we brace, where we prepare ourselves for what is inevitable now ... based on the travel we have just seen in the last week and the expectation of more of the same through the rest of the holiday season of a surge on top of a surge, arguably, on top of, again, another surge," Newsom said.
California reported more than 31,000 new cases Tuesday and 242 deaths, but the numbers are likely to climb this week as labs and counties catch up their reporting from the holiday week.
State officials also notified hospitals that the situation is so dire they should prepare for the possibility that they will have to resort to "crisis care" guidelines established earlier in the pandemic, which allow for rationing treatment.
Information for this article was contributed by Marisa Iati, Joel Achenbach, Ben Guarino, Lena H. Sun and Isaac Stanley-Becker of The Washington Post; and by Alexandra Jaffe, Brian Melley, Janie Har, Don Thompson, Christopher Weber, Stefanie Dazio and John Antczak of The Associated Press.