I’m doing some reading on this now.
Let’s use California as a model. Their first shipment was 327,000 vaccines. That seems to be allotted primarily to health care workers, of which there are 2.4 million in the state. None of those are expected to go to staff and residents of long-term care facilities, who are also supposed to be part of the first round of vaccinations.
They can’t really go on to the next phase in part because they apparently haven’t agreed on who is part of that phase. In general, after LTCFs and frontline medical staff, the general direction is to vaccinate the elderly and essential workers. They are quibbling over who is essential. Law enforcement? Agricultural workers? Several industries are lobbying for their workers to be considered essential (so they can go back to maximally exploiting them, I presume).
Cold storage does seem to be a bit of a problem.
Counties have been asked to provide the state with information about their vaccine distribution plans and their cold storage capacity.
“But all the plans are sketchy, and many of them say ‘we plan to plan’ because we don’t know what will be available,” Trochet said.
Also:
During the 2009 H1N1 pandemic, the county set up temporary sites in various communities to rapidly vaccinate several people at once. But the Pfizer vaccine presents a logistical challenge the county hasn’t dealt with before because it must be kept extremely cold.
The county Department of Health Services — which operates four public hospitals and 27 clinics — recently bought eight subzero freezers that altogether can store more than 1 million doses.
https://www.capradio.org/articles/2020/12/31/with-more-vaccine-doses-coming-california-counties-scramble-to-make-distribution-plans/
So, right now, it seems like they are still ironing out details of who can administer the vaccine and where and issues of storage. Places need to buy special freezers if they want to use the Pfizer vaccine. As I noted before, other countries are waiting to figure this all out before they start giving people shots. The US has taken the strategy of trying to do a partial rollout while figuring this out on the fly. It will get better.
You also have to consider the lag in the supply chain. While x number of vaccine has been produced, they couldn’t give those all out this week if they tried. A lot of doses will still be at the factory awaiting shipment. There’s apparently some sort of limit to how many doses they can load on a plane to ship to a far-off state because keeping them sufficiently cold presents a safety issue. If