A year after the first cases of COVID-19 appeared in the United States, the gargantuan task of vaccinating 328 million Americans is progressing at anything but warp speed. The absence of a coordinated national response, inadequate funding for states and localities, and chronic lack of investment in public-health infrastructure have, perhaps predictably, hampered admittedly ambitious rollout goals and tempered the optimism that came with the arrival of effective vaccines from Pfizer and Moderna last fall.

The federal government had hoped to vaccinate at least 20 million people by the end of 2020. But according to the CDC, a month into 2021 only 10 million people have received the first of two required doses, and just 1.6 million have been fully vaccinated. While the Trump administration’s $18 billion Operation Warp Speed initiative accelerated vaccine development, only $340 million of that was allocated to help states administer shots. The federal relief bill passed in December included $8 billion for vaccine distribution, but it would have been far better had the money come much sooner. “States can’t make a contract or plan for anything or hire someone until they have that money on hand,” said Kelly Moore, the deputy director of the Immunization Action Coalition.   

Neglecting to set a clear national strategy, the Trump administration left states to handle their own vaccine rollout, though many were already overwhelmed from dealing with the pandemic so far. Georgia, Alabama, Mississippi, and South Carolina have vaccinated less than 2 percent of their residents. New York Gov. Andrew Cuomo faced criticism for threatening $1 million fines for not following distribution requirements, even as unused doses expired. But the rollout in Florida, the state with the second-highest number of people over the age of sixty-five, has been particularly chaotic. Older Floridians have encountered crashing websites, and county phone lines have been swamped with calls (in some cases receiving up to two thousand per minute). The proliferation of fake vaccine-appointment postings has only added to the confusion, especially as real appointments remain available. Some Florida counties have turned to the website Eventbrite, better known for registering for bar crawls and concerts, to organize appointments.

The uneven rollout also reveals the price of failing to invest sufficiently in public-health infrastructure. The United States spends $3.6 trillion on health care annually, but less than 3 percent of that goes to public health. Public-health initiatives have “saved the most lives by far, for the least amount of money,” Tom Frieden, a former director of the CDC, said in an interview with the New York Times Magazine, “but you’d never guess that based on how little we invest in it.” That has left states scrambling to find freezers and equipment for storing the vaccines, train and hire people to administer doses, and fund public-outreach campaigns to convince people who might otherwise be unwilling to or unaware of how to get a vaccine. (As of December 2020, 27 percent of Americans said they still wouldn’t get a free COVID-19 shot—a crisis in its own right.) 

A week before his inauguration, with the number of COVID-19 deaths approaching 400,000, Joe Biden detailed the specifics of his American Rescue Plan, a $1.9 trillion coronavirus relief package that would allocate $20 billion for a national vaccination program. The plan lays out a more involved role for the federal government in accelerating vaccine distribution, and proposes making the vaccine free to everyone regardless of immigration status. It’s a promising first step toward achieving his goal of 100 million vaccinations during his first hundred days in office. Hopefully, it’s also the start of a much-needed reinvestment in public health writ large.