No indication White House will overhaul vaccine distribution despite widespread problems

Officials tell CNN they are sticking with their policy to leave it up to states to carry out vaccination campaigns. They are encouraging states to open up vaccines to a wider population -- beyond frontline health care workers and long-term care residents -- and urging them to more swiftly move vaccines to pharmacy settings in the hopes of speeding up vaccination rates.

States, meanwhile, say the federal government has been slow to realize the problem and should have given states more money earlier to develop specific plans. The presidential transition has made things more complicated as well, some officials said.

More than 17 million vaccine doses have been distributed to states but just 4.8 million Americans have received their first dose of the vaccine, according to data from the Centers for Disease Control and Prevention.

"We'll work with the states," said Moncef Slaoui, the head of Operation Warp Speed on Monday. But, "we need specific requests for help."

Administration officials believe that the vaccine rollout coinciding with the holidays has contributed to delays in both vaccine administration and reporting, and officials insist they expect vaccination rates to jump in the coming days and weeks.

"I think we should wait until the first and second week in January to see if we can catch up with the pace," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said at a Newsday event Tuesday.

In the meantime, administration officials are also urging states to widen the groups that are eligible for vaccinations and ramp up shots at local pharmacies.

"Your headline today really should be: 'Surgeon General tells states and governors to move quickly to other priority groups,'" Surgeon General Dr. Jerome Adams told NBC News Tuesday.

Adams said states felt beholden to guidelines from a CDC advisory committee recommending that states vaccinate all health care workers and long-term care residents before moving on to other populations. If, for example, health care workers don't want the vaccine, he said states should move on to the next group.

"Get those vaccines where they're going to be taken up," Adams said. "We don't need to re-create the wheel, we just need to get it rolling."

But even within the administration, officials are struggling to get a clear picture of which states have actually been slow to vaccinate residents and which have simply been slow to report their numbers. That has made it more challenging for the federal officials to determine if they should be offering targeted assistance to certain areas.

"We are looking at what's working currently, and we will be helping states course correct," a senior administration official said.

The official noted that lines of Americans waiting to get vaccinated is preferable to doses languishing on shelves or being tossed. "We'd rather see demand meeting supply than worrying whether doses are sitting on a hospital shelf," the official said.

One state official said it appears to finally be dawning on federal officials that states needed additional resources to ramp up hiring in public health departments, organize vaccine sites and upgrade tech systems to track who is getting vaccinated. The Covid relief package Congress passed in December included $8 billion for vaccine distribution, funds state official said would have been even more useful six months ago.

"It's frustrating that they spent so long not appreciating and not understanding the deep, very real resource needs that states had," the official said.

Still, there's no indication the federal government plans to take on a bigger role, aside from some discussion about whether the National Guard should be more involved, said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials.

"There was a lot of effort put into developing the vaccine. There hasn't really been the same amount of effort of putting things into place to be able to administer it," Plescia said.

The senior administration official noted that states are welcome to request additional support from both the National Guard and the Federal Emergency Management Agency.

Trump's checked out and the transition is hampering efforts

The slow vaccine effort coinciding with the presidential transition has made the situation more precarious, leaving state and local officials straddling conversations with the Trump administration and the incoming Biden administration.

Trump has largely checked out on the vaccination effort, distracted by his attempts to cling to the presidency that he has lost. While Vice President Mike Pence is slightly more dialed in -- and is still convening coronavirus task force meetings -- he, too, is primarily focused on the political fight, said a source familiar with the situation.

In a late December tweet, the President blamed states for the slow vaccine rollout, saying, "The Federal Government has distributed the vaccines to the states. Now it is up to the states to administer. Get moving!"

As for President-elect Joe Biden, he has already set an aggressive goal of 100 million shots in arms in his first 100 days in office.

But Biden has offered only limited details on how he plans to hit that target that would vaccinate 50 million people. He has said he will more aggressively use the Defense Production Act to churn out more vaccine supplies and personal protective equipment. And he has also suggested the federal government will take a more prominent role in organizing vaccination sites and mobile vaccination units for hard-to-reach communities.

In an Atlanta radio interview with the Kenny Burns Show Tuesday, Biden said he would "establish thousands of federally run and federal supported community vaccination centers of various sizes across the country, located in high school gyms or NFL football stadiums," with the help of FEMA, the CDC, the US military and the National Guard.

"This is going to be a coordinated, hand-in-hand effort, all the way through to make sure we're getting those vaccines into the arms of people in every pocket, in the rural communities, in the hard-to-reach areas, in the Latinx and Black populations and tribal nations," Rick Bright, a member of Biden's coronavirus advisory board, told CNN Monday.

While the Biden team has been reaching out to governors and health officials across the country, people involved in the calls described them primarily as listening sessions that shed little light on how Biden plans to turnaround the thorny problem of slow vaccination rates.

"It starts with them absolutely understanding what's going on in reality and what has to be adjusted," said Lori Tremmel Freeman, chief executive officer at the National Association of County and City Health Officials, who has been talking to members of Biden's team in recent weeks. "But it's a weird place to be at this moment in time and between administrations when you're dealing with the biggest health threat of our lives. You cannot put anything on hold. People are dying every day."