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story.lead_photo.caption This undated electron microscope image made available by the U.S. National Institutes of Health in February 2020 shows the Novel Coronavirus SARS-CoV-2. Also known as 2019-nCoV, the virus causes covid-19. - Photo by NIAID-RML via AP

WASHINGTON -- The Trump administration announced changes to its vaccination rollout Tuesday, including making all of the coronavirus vaccine supply immediately available, urging states to provide shots to anyone 65 and older and warning that states with lagging inoculations will lose some of their shots to speedier places.

The steps, part of an effort to accelerate a delayed and disjointed rollout, depart from the administration's original strategy, and come just days after President-elect Joe Biden announced plans to release nearly all the vaccine supply.

Biden is expected to provide a detailed blueprint on reinvigorating the rollout later this week, including likely calling for inoculations of everyone 65 and older and expanding the number of venues where shots are administered, according to two people familiar with the deliberations who spoke on the condition of anonymity because they were not authorized to discuss them.

But it is not clear how, or even if, the outgoing administration's plan to change state allotments of vaccines will play out. Health and Human Services Secretary Alex Azar said at a briefing that in two weeks, the government would begin "redirecting" shots to states based on the size of their 65-and-older population and the pace of their vaccinations. States doing a poor job of getting shots into arms could see their allotments shifted to states performing better, he said, noting that about 10 states might be affected. The current allocation system is based on a state's population.

Federal officials have complained that the data on state immunization efforts is incomplete and that states vary significantly in how many of the shots given to people are reported within the required three days.

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"This new system gives states a strong incentive to ensure that all vaccinations are being promptly reported, which they're currently not," Azar said. "And it gives states a strong incentive to ensure that doses are going to work protecting people rather than sitting on shelves or in freezers."

But Azar, a Trump Cabinet secretary, will be gone in a little over a week, and it is unclear whether the Biden camp endorses the idea. The president-elect's transition team declined to comment on it. Other federal health officials expressed concern that the changes would cause confusion, and questioned how they could be enforced, said one health official who spoke on the condition of anonymity to share internal discussions.

State health officials, meanwhile, denounced the plan as punitive.

"It is too early to begin to judge how well states are administering this, and a punitive approach isn't going to help us reach our goal of vaccinating the entire population as safely and quickly as possible," said Michael Fraser, who heads the Association of State and Territorial Health Officials.

Since the mass vaccination effort began last month, the Trump administration has held back roughly half of the vaccine to ensure sufficient supply for people to get the required second shot. Under the new policy, the expectation is that people will still get their second doses about a month later, as planned. Azar and other Operation Warp Speed officials, who oversee vaccine distribution, said concerns about possible hiccups in manufacturing and distribution have been allayed by the steady ramp-up.

Over the next two weeks, Azar said, doses held in reserve will be shipped out based on states' orders. Beyond that, he said, the available doses will be released first to cover second doses and then to provide additional first vaccinations.

Ohio Gov. Mike DeWine, a Republican, called the move to release all available doses a "welcome change."

"More details will be coming," he said at a briefing Tuesday. "It is in fact very good news."

Other supporters said that while releasing more vaccines could mean some people will face a short delay in getting second shots, the risk of delayed inoculations is much greater as the pandemic claims thousands of lives daily and as a new, more contagious variant of the virus first identified in Britain spreads through the United States.

Critics, however, worry that an unforeseen and extended delay of the booster shot could undermine the efficacy of the vaccines.

The Pfizer-BioNTech and Moderna vaccines -- the only two coronavirus vaccines that have been cleared by the Food and Drug Administration -- were shown in clinical trials this year to be highly effective when administered in a two-shot regimen. The second Pfizer shot is given after 21 days, and the second Moderna shot after 28 days.

Separately, health officials announced Tuesday that anyone flying to the U.S. will soon need to show proof of a negative test for covid-19.

The Centers for Disease Control and Prevention requirement expands on a similar one announced late last month for passengers coming from the United Kingdom.

Covid is already widespread in the U.S., with more than 22 million cases reported to date, including more than 375,000 deaths. The new measures are designed to try to prevent travelers from bringing in newer forms of the virus that scientists say can spread more easily.

The CDC order is to take effect Jan. 26. It requires air passengers to get covid-19 tests within three days before their flights depart to the U.S., and to provide written proof of the test results to the airline. Travelers can also provide documentation that they had the infection in the past and recovered.

Airlines are ordered to stop passengers from boarding if they don't have proof of a negative test or a previous infection.

"Testing does not eliminate all risk," CDC Director Robert Redfield said in a statement. "But when combined with a period of staying at home and everyday precautions like wearing masks and social distancing, it can make travel safer, healthier, and more responsible by reducing spread on planes, in airports, and at destinations."

BROADER CRITERIA

The administration's call to states to broaden access to people 65 and older and those under 64 with high-risk medical conditions sharply increases the potential number of people seeking shots to about 184 million, intensifying demand on already stressed sign-up systems.

Under the original CDC recommendations, about 74 million people are in the first priority groups for vaccination: health care workers; staffers and residents of long-term-care facilities; front-line essential workers; and adults 75 and older.

Neither Azar nor other Warp Speed leaders addressed how expanding the priority age groups would affect access to vaccine for front-line essential workers, from grocery store clerks to bus drivers, who had been in the next group prioritized for vaccination in many state plans. Azar noted that some states, such as Florida and Texas, already are vaccinating those 65 and older, and called it a faster way to protect many of the most vulnerable.

But Jason Schwartz, an assistant professor of health policy at the Yale School of Public Health, said on Twitter that the change could usher in "a free-for-all."

"This seems like chaos," he added. "Effectively telling 100 million-plus people that they are eligible for vaccines now, while knowing that most will have to wait for several months to actually get it" will cause rampant frustration.

Others noted that the priority recommendations from a CDC advisory committee were a compromise between the desire to shield front-line essential workers who are disproportionately members of minority groups and most likely to catch and transmit the virus because they cannot work from home, and to protect older people who are most prone to serious complications and death.

The change in the vaccination plans was discussed with governors in a meeting Tuesday afternoon chaired by Vice President Mike Pence.

Some critics say the administration's planning should have extended into helping states administer the shots after they are delivered. Congress has recently approved more than $8 billion for that.

The slow pace of the vaccine rollout has frustrated many Americans at a time when the coronavirus death toll has continued to rise.

Azar said the pace of vaccinations has picked up, on track to reach 1 million daily within a couple of weeks. But the American Hospital Association estimates that 1.8 million vaccinations a day are needed, seven days a week, to achieve widespread immunity by the middle of this year. Biden has set a goal of 100 million shots administered in his first 100 days.

VACCINATION SITES

To speed up vaccination efforts, California is transforming baseball stadiums, fairgrounds and even a Disneyland Resort parking lot into mass vaccination sites as the coronavirus surge overwhelms hospitals and sets a deadly new high in the state.

California's covid-19 death toll reached 30,000 Monday, according to data collected by Johns Hopkins University.

It took six months for the nation's most populous state to reach 10,000 deaths but barely a month to jump from 20,000 to 30,000 deaths. California ranks third nationally for covid-19-related deaths, behind Texas and New York, which is No. 1 with nearly 40,000.

Public health officials have estimated about 12% of those who catch the virus will require hospital care, usually several weeks after infection as they get sicker.

Gov. Gavin Newsom and public health officials are counting on widespread vaccinations to help stem the tide of new infections, starting with medical workers and the most vulnerable elderly, such as those in care homes.

Orange County, south of Los Angeles County, announced Monday that its first mass vaccination site will be at a Disneyland Resort parking lot in Anaheim. It's one of five sites to be set up to vaccinate thousands of people daily.

The sites are "absolutely critical in stopping this deadly virus," county Supervisor Doug Chaffee said in a statement.

The state will vastly expand its effort with new mass vaccination sites at parking lots for Dodger Stadium in Los Angeles, Petco Park in San Diego and the CalExpo fairgrounds in Sacramento.

NO TASTE FOR CURBS

Meanwhile, governors and local officials in hard-hit parts of the country are showing little willingness to impose any new restrictions on businesses to stop the spread.

And unlike in 2020, when the debate over lockdowns often split along party lines, both Democratic and Republican leaders are signaling their opposition to forced closings and other measures.

Some have expressed fear of compounding the heavy economic damage inflicted by the outbreak. Some see little patience among their constituents for more restrictions 10 months into the crisis. And some seem to be focused more on the rollout of the vaccines that could eventually vanquish the threat.

The most notable change of tune came from New York Gov. Andrew Cuomo, a Democrat, who imposed a tough shutdown last spring as the state became the epicenter of the U.S. outbreak.

"We simply cannot stay closed until the vaccine hits critical mass. The cost is too high. We will have nothing left to open," Cuomo said this week as confirmed infections in the state climbed to an average of 16,000 a day, and deaths reached about 170 per day.

Theaters remain closed and there is no indoor dining in New York City, but Cuomo said Tuesday that if a system of rapid virus tests could be developed, it could allow those things to return more safely.

In Arizona, where the pandemic is raging, Republican Gov. Doug Ducey has been steadfast in his opposition to a statewide mask mandate or the closing of bars, gyms and restaurant dining despite repeated calls from hospital leaders to take such steps.

"If we're really all in this together, then we have to appreciate that for many families 'lockdown' doesn't spell inconvenience; it spells catastrophe," Ducey said.

Governors in other hot spots, including Texas, have expressed similar sentiments, while other states are loosening restrictions even as the U.S. death toll closes in on 380,000 and cases top 22.7 million. Deaths nationwide are running at more than 3,200 a day on average.

Minnesota allowed in-person dining to resume this week, and Michigan is to do the same Friday. Nevada's rules are to expire Friday.

Information for this article was contributed by Lena H. Sun, Laurie McGinley, Isaac Stanley-Becker and Amy Goldstein of The Washington Post; and by Mike Stobbe, David Koenig, Don Thompson, John Antczak, Robert Jablon, Christopher Weber, Ricardo Alonso-Zaldivar, Zeke Miller, Alan Suderman, Candice Choi, Carole Feldman, Lauran Neergaard, Michelle R. Smith, Julie Watson, Terry Tang, Jennifer Peltz and Marina Villeneuve of The Associated Press.

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