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Just weeks into the country’s coronavirus vaccination effort, states have begun broadening access to the shots faster than planned, amid tremendous public demand and intense criticism about the pace of the rollout. Some public health officials worry that doing so could bring even more chaos to the complex operation and increase the likelihood that some of the highest-risk Americans will be skipped over. But the debate over how soon to expand eligibility is intensifying as deaths from the virus continue to surge, hospitals are overwhelmed with critically ill patients and millions of vaccine doses delivered last month remain in freezers. (Goodnough, 1/19)

Weeks into the national rollout of COVID-19 vaccines, states have inoculated just a fourth of the number of Americans they expected to—hamstrung by a lack of federal and state leadership, too little money and the dovetailing public health crises of surging hospitalizations and case numbers. States also continue to adjust their priorities on who should be next in line for the shots, sometimes with poor communication to providers and the public. And in some states, wealthy or connected individuals have leapfrogged to the front, defying public health guidelines. (Vasilogambros, 1/8)

Supply-chain experts attribute the delays in part to the burdens faced by often underfunded state and local health agencies already stretched to their limits by the coronavirus pandemic, along with communication problems including confusion over how many doses states were set to receive. But experts also point to guidance from a federal vaccine advisory panel on who should be inoculated first, which recommended that the limited initial supply of doses be administered to health-care workers and residents of long-term-care facilities. (Smith, 1/11)

Less than a third of doses delivered to Pennsylvania and New Jersey had been administered, according to data from the Centers for Disease Control and Prevention, although officials in both states say the tally is undercounted due to reporting lags and say their pace is already accelerating. Friday brought signs that the effort was ramping up as promised: In the first three weeks of vaccine distribution, more than 160,000 doses were reported to have been administered in Philadelphia and Pennsylvania. By Friday, that number had increased by about 110,000. (Laughlin and McDaniel, 1/9)

No group has suffered more during the COVID-19 pandemic than staff and residents of nursing homes, where high concentrations of elderly people with serious health problems created the perfect killing ground for the virus. Still, the effort to vaccinate people in those homes is rolling out at a frustratingly slow pace, according to experts nationwide. As of Friday, only about 17% of the more than 4 million vaccine doses distributed to long-term care facilities had been injected, according to the federal Centers for Disease Control and Prevention. (Dolan, 1/9)

Linda Kleindienst Bruns registered for a coronavirus vaccine in late December, on the first day the health department in Tallahassee, Fla., opened for applications for people her age. Despite being 72, with her immune system suppressed by medication that keeps her breast cancer in remission, she spent days waiting to hear back about an appointment. “It’s so disorganized,” she said. “I was hoping the system would be set up so there would be some sort of logic to it.” (Mazzei, Adelson and Kelly, 1/10)

West Virginia deployed National Guard units to get first doses of the vaccine to every nursing home before New Year’s Day. In South Dakota, the Civil Air Patrol waited at the Sioux Falls airport to ferry vaccines to remote parts of the state. And a small hospital in Nebraska’s corn and soybean belt mixed logistics with a can-do attitude to vaccinate front-line staffers hours after its precious shipment arrived.“ We’re getting it out there as quickly as we receive it,” said Daniel Bucheli, a spokesman for the South Dakota Department of Health. “Shots in arms — that’s the goal.” (Weisman, Freyer and Moore, 1/9)