Several states have reported shortages of Covid-19 vaccine doses, leading to tens of thousands of appointments being canceled and calls for the federal government to improve vaccine distribution.

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States report vaccine shortages

In total, less than half of the 36 million doses of Covid-19 vaccines sent to states by the federal government have been administered, according to CDC. Health officials have said that gap could be a result of delays in recordkeeping and failings at different governmental levels. Moderna has said it is on track to manufacture 100 million doses by the end of 2020's first quarter and 200 million by the end of the second quarter, and Pfizer said it is on track to produce 200 million doses by the end of July.

Yet, despite the manufacturing progress, states have reported problems with the vaccine distribution process. At the start of the vaccine rollout, some states were struggling to use all the doses they'd received. But now, many are reporting that they do not have enough vaccine doses to keep up with demand—and that hospitals, in turn, have had to cancel appointments. Hospitals in Michigan, for example, have canceled "many" appointments over the past five weeks because of vaccine shortages, according to the Michigan Health and Hospital Association, as has the Baptist Health system in Florida.

States call out supply chain issues, lack of clarity

States have cited multiple reasons for the shortfalls. In New York City, Mayor Bill de Blasio (D) on Wednesday said the city has canceled 23,000 vaccination appointments because Moderna's distributor delayed a shipment of 103,000 doses the city expected to receive on Tuesday.

"This is purely a shipment issue, a logistical issue," Dave Chokshi, New York City health commissioner, said on Wednesday.

According to McKesson Corp., which distributes Moderna's vaccines, some shipments were delayed because vaccines were arriving to sites colder than the temperature range provided by Moderna, although Bloomberg reports that it wasn't clear whether that was the same issue plaguing the New York City shipment.

Other states have reported similar supply shortages. In Hawaii, officials said the state received 59,000 doses last week but is only expected to receive around 32,000 this week, while officials in San Francisco's health department received 12,000 doses last week but fewer than 2,000 doses this week

Others have not seen declines, but have not seen increases in doses being shipped either. "We have the capacity to get our population vaccinated to move through the priorities very quickly. But the supplies have not increased; they're level right now," Arkansas Gov. Asa Hutchinson (R) said. "We all fully expected our great manufacturing enterprises to accelerate the manufacturing, and we're not realizing it yet."

Communication has also been a problem, Politico reports. Health officials have said the federal government needs to provide states with more accurate estimates on vaccine shipments weeks in advance so states can properly plan. But currently, officials say they've typically received notice less than a week before shipments arrive.

Some officials also say the Trump administration's decision to encourage states to vaccinate people 65 and over as well as those with high-risk medical conditions without increasing vaccine supply exacerbated the issue. "That announcement last week put the pressure and the expectation on us that we would go down to 65," Kris Ehresmann, an official at the Minnesota Health Department, said.

That said, not all states followed the recommendations. Colorado, for example, opted to limit vaccines to people 70 and older, and Maryland expanded to only those 75 and older. Going a step further, Oregon rescinded its plans to expand eligibility once it learned that the government's reserve of vaccines had already been expended, and Vermont Gov. Phil Scott (R) said his state won't expand eligibility at all until it gets more doses.

"With such a limited and unpredictable supply of vaccine coming to us, we're prioritizing those most likely to die if they contract [the novel coronavirus]," Scott tweeted. "Over-promising is not the answer. The logical approach is to manage the supply of the vaccine we're receiving and if we're allotted more, then we'll scale up—which we hope is the case."

Separately, Colorado Gov. Jared Polis (D) said he's told the Biden administration—which has set a goal to vaccinate 100 million people in 100 days—that his state needs three to five times the vaccine supply it's currently receiving. "If we are going to reach 100 million people in 100 days, then the federal government has to pick up the pace," Polis said.

Similarly, Ohio Gov. Mike DeWine sent a letter to the Biden administration pleading for more vaccine doses. "We are not lacking the infrastructure," DeWine said in the letter. "We are lacking the vaccine."

Officials recalibrate expectations

Amid those ongoing concerns, Rochelle Walensky, the new CDC director, earlier this week said while the Biden administration is on track to meet its goal of 100 million vaccine doses within President Biden's first 100 days, she "also want[s] to be very cognizant of the fact that after 100 days there's still a lot of Americans who need vaccines."

Specifically, she pushed back on estimates provided by former HHS Secretary Alex Azar, who had previously indicated that Covid-19 vaccine doses would be available in pharmacies throughout the country by the end of February. "I'm going to tell you the truth here," Walensky said. "I don't think late February we're going to have vaccines in every pharmacy in this country."

Nonetheless, Walensky said that as data continues to emerge, particularly on the Johnson & Johnson vaccine candidate, the administration is prioritizing making as many doses available to the public as possible. "We recognize this is the most immediate emergency, to get this country back to health," she said (Kelley, The Hill, 1/22; Fieldstadt, NBC News, 1/21; Hill/Peltz, Associated Press, 1/20; Roubein/Ehley, Politico, 1/20; Goldman, Bloomberg, 1/20).