CONFUSION seen in early stages of vaccine effort.

Distribution varies across U.S.

After months of anticipation, millions of doses of the two authorized coronavirus vaccines — made by Pfizer-BioNTech and Moderna — are flowing into hospitals and health departments across the nation. But Americans trying to gain access to the shots are encountering systems that vary widely from county to county and that, in many places, are overwhelmed.

Some counties and hospital systems launched reservation websites, only for them to quickly become booked or crash. Others announced appointments only through Facebook, with slots filling before some people knew to look. And many have not revealed how the vaccine will be made available to anyone beyond health care workers and long-term care residents and employees, the focus of the first round of vaccinations.

On Sunday, Moncef Slaoui, chief science adviser to Operation Warp Speed, the Trump administration’s effort to expedite development and delivery of vaccines, said on CBS’ “Face the Nation” that his team is available for requests from states for assistance.

“We need to improve,” he acknowledged.

Surgeon General Jerome Adams said vaccine administration was accelerating, with 1.5 million doses given in two days. Speaking on CNN’s “State of the Union,” Adams said Sunday that he’s “still optimistic” about the national outlook for defeating the virus.

About 4 million of the 14 million doses delivered to states have been administered, according to Centers for Disease Control and Prevention figures.

Federal officials had estimated that 20 million doses of vaccine would be delivered and administered by the end of 2020. Adams pointed to a strain on resources brought on by the nationwide surge in covid-19 cases and by the holidays as possible causes of the slower-than-expected rollout, while President Donald Trump has blamed states.

“I’m telling you that things are changing,” Adams said, adding that the administration’s coronavirus task force is “working every single day to figure out how we can help the states.”

At the state and local levels, authorities urge patience as they sort out distribution plans. Michael Kilkenny, physician director of West Virginia’s Cabell-Huntington Health Department, described it as a “massive logistical operation.”

There has been confusion over when, where and how to get the shots, with different jurisdictions taking different approaches in the nation’s patchwork, decentralized public health system.

Even health care workers have struggled to figure it out. Marla Deibler, a psychologist in New Jersey, said people in her line of work were unsure whether they qualified, with professional email listservs full of questions about the vaccine. Through “lots of investigating,” she found a hospital that was inoculating health care workers and made an appointment by phone.

The state on Wednesday sent providers an email listing vaccination sites. By then, she’d already been pricked.

“In my experience, just because there hasn’t been a central plan, it just hasn’t been managed well in terms of how to carry this out,” Deibler said. “But once we knew what to do, it went very smoothly.”

In several states, health officials were caught off guard when governors suddenly announced availability would expand to senior citizens or others. Some state officials chose to depart from CDC guidelines for the second vaccination priority group, comprising front-line essential workers and people 75 and older.

Hospitals and county health departments in Florida scrambled to accommodate the demand after Gov. Ron DeSantis’ Dec. 23 announcement that the state would prioritize senior citizens over essential workers. Counties and hospitals were left to make plans on their own, with the governor saying Wednesday that each would be “offering the vaccine in ways that best fit the needs of that particular community.” That approach, he added, “cuts out the middle man.”

At Memorial Healthcare System in Broward County, Fla., officials responded to the governor’s mandate by asking his office for more doses, according to system spokeswoman Kerting Baldwin. The system made the request Tuesday, she said Wednesday, adding that the hospital system is “receiving calls from people who want the vaccine, but it is not available at this time.”

On the opposite side of the state, Lee County authorities announced that anyone older than 65 could be inoculated, with no appointment necessary. They decided it was the most expeditious way to get vaccine out, County Commission Chairman Kevin Ruane said.

The sole Democratic member of the Florida Cabinet blasted the lack of preparation and progress as “inexcusable.” Agriculture Commissioner Nikki Fried urged the governor to mobilize the National Guard, writing in a Wednesday letter that vulnerable Floridians had been “left without answers or clear direction from overwhelmed local agencies on when, where and how to receive the vaccine.”

New Mexico has a website where residents can register to be vaccinated and find out, via text message, whether to keep waiting or head to a specific location to get the shot. Several Oklahoma counties posted vaccine signups on their Facebook pages; some residents complained they weren’t given notice and that many were still unaware of how to get an appointment.

In Texas, the Department of State Health Services created an online map showing all the providers that have received vaccine shipments. Before it can be viewed, a pop-up warns that “not all providers are vaccinating the public or people in all priority groups” and directs users to call in advance.

But after Republican Gov. Greg Abbott and state health commissioner John Hellerstedt pressed for vaccine providers to move more quickly, some clinics saw lines form outside. The commissioner had said in a statement that there was “no need” to ensure that everyone in the first priority group — health care workers and staffs and residents of long-term care facilities — was vaccinated before moving on to the next, which in Texas includes senior citizens and those with underlying conditions.

Officials with the Northeast Texas Public Health District were surprised Wednesday when hundreds of people, mostly senior citizens, showed up at a vaccine clinic it was hosting in Tyler. Of the 1,000 doses the agency has received so far, nearly 600 were administered in one day. George Roberts Jr., the health district’s chief executive, said it had gone “amazingly well, under the circumstances.”

“There’s been understandable hiccups — this is a big program, it came just as we were entering the holidays,” said Josh Michaud, associate director for global health policy at the nonprofit Kaiser Family Foundation. “There are many aspects that are complicated here. But the number of people that’s been actually vaccinated has been, I think, below a lot of people’s expectations.”