NEW YORK (BLOOMBERG) - US health officials acknowledged that a Covid-19 immunisation campaign is crawling out of the starting gate, raising the prospect that the nation's all-in bet on vaccines could be afflicted by the same dysfunction that hobbled other measures to contain the pandemic.

Only about 2.7 million Americans had been vaccinated as of Wednesday evening (Dec 30) in New York, according to Bloomberg's vaccine tracker. With one day remaining in the year, that represented roughly 13.5 per cent of the US's stated goal of immunising 20 million Americans by the end of 2020 - a number already repeatedly reduced.

The task of delivering shots that could end a pandemic that has killed 341,000 US residents is taxing a largely private medical system designed to maximise profit rather than deliver public health. Governments and institutions are struggling with complex logistics to keep the shots cold, organising cohorts of people to receive them and persuading those made skeptical by a flood of online disinformation.

Dr Robert Wachter, chairman of the department of medicine at the University of California, San Francisco, said the Trump administration is repeating its grave errors in providing tests and personal protective equipment.

"It's another manifestation of a lack of a federal plan with appropriate resources. It's the testing problem now just applied to a different setting. Not just testing but PPE," Dr Wachter said.

"Each one of these has been sad. This one could be tragic. With each passing day, if vaccines are sitting on shelves waiting to be administered, those are people that will die because of that."

Senior public-health officials said the vaccination pace will accelerate as soon as next week. Nursing homes and other long-term care facilities are likely to get more shots done as the new year dawns and the holidays recede, said Dr Nancy Messonnier of the US Centres for Disease Control and Prevention (CDC).

The leader of the logistics effort said that it will take time to understand why uptake has proceeded so slowly.

"We developed and launched a new data system that connects hundreds of existing systems at the state and local level, to allow us to have visibility so that we can see ourselves across the entire United States," said Army General Gustave Perna.

Meanwhile, states are improvising new delivery systems and rewriting priorities for who should get access to shots first.

Colorado on Wednesday said it would vaccinate people 70 and older, joining Texas and Florida in trying to quickly immunise older residents - even though federal guidelines favour health-care workers. Other cities and states are just now registering recipients, weeks after the Trump administration made clear it considered its job done once vaccines were delivered to hospitals and agencies.

West Virginia finished giving the first of two required shots to residents and employees of long-term care facilities, the first state to do so, Governor Jim Justice said on Wednesday. The state is now vaccinating prison guards and emergency workers, and then will target teachers and residents 80 and older, Mr Justice said.

Prof Julie Swann, a supply-chain expert at North Carolina State University, said prioritising groups for initial shots is an impediment. States are consciously weighing the competing values of protecting specific people, such as medical workers, against immunising the general population as quickly as possible.

"We have multiple competing objectives, and it's hard to satisfy them simultaneously," Prof Swann said.

Dr Messonnier, director of the CDC's National Centre for Immunisation and Respiratory Diseases, attributed the slow rollout to public health departments being strained by the pandemic, launching the inoculation campaign amid the holiday season and the Covid-19 vaccines' special handling and storage requirements.

The formula created by Pfizer Inc and BioNTech SE needs to be stored at -70 deg C. That makes the logistics more complicated than a simple flu shot, said Ms Kris Ehresmann, infectious-disease director of the Minnesota Department of Health.

"This is a new vaccine with new processes that have to be put in place, and that adds some time," Ms Ehresmann said Wednesday.

At least three shipments of Moderna Inc's vaccine were held back in Texas last week because they displayed signs of falling out of the required temperature range.

The federal officials said they will assess what's working and what needs to be adjusted. "Here's what I have confidence in: Every day, everybody gets better and I believe that uptake will increase significantly as we go forward," Gen Perna said.

State Struggles

President-elect Joe Biden has said the administration is failing to protect Americans and has promised 100 million inoculations in his first 100 days if Congress provides funding. But President Donald Trump made clear in a Wednesday morning tweet he believe local officials are in charge, telling states: "Get moving!"

New York Governor Andrew Cuomo during a news conference on Wednesday said the massive undertaking has been "grossly underestimated". Ohio Governor Mike DeWine chastised providers for moving slowly. Only 17 per cent of the doses distributed have been administered in the state, which is home to some of the largest health-care systems in the country, such as the Cleveland Clinic.

Logistical issues are slowing vaccinations in hospitals, Mr DeWine said. In long-term care facilities, few workers want the shots. About 60 per cent of those who have been offered a vaccine have refused it, Mr DeWine said.

Ground-level logistics can be opaque across the US. Many residents are uncertain whether they will get a shot from their doctor, at a government clinic or at a pharmacy. It's unclear how government officials will verify eligibility. Some states and cities have launched websites where residents can sign up to be vaccinated.

Sorry, No

Health-care workers are the only people who can register in the District of Columbia. New Mexico created an online portal that allows people to register for vaccination after entering basic information. The state promises to contact registrants when the shot is available.

Essex County, New Jersey, has a system that in two clicks turns away people who aren't in health care or otherwise qualified: "Based on your response you are currently not eligible for vaccination at this time. Please be sure to check back as CDC releases new phases and guidelines."

Some states are already starting to offer the vaccine more widely than the federal government recommends. In Colorado, the vaccine will be available to everyone 70 and up, Governor Jared Polis said on Wednesday. Some areas may focus on health-care workers while others may start providing it to senior citizens.

Texas this week opened up vaccination to seniors 65 and older and people over 16 with an increased risk for severe illness. Governor Greg Abbott in a tweet on Tuesday urged vaccine providers to quickly use shots, because a "significant portion" may be going unused.

Dr Wachter, the California medical professor, said states are making it up as they go.

"These are big, complex undertakings to get materials out to millions of people, thousands of places, and they really do require federal coordination, federal programs and federal dollars behind them," he said. "If you don't you have everybody doing improv and it just doesn't work very well."