(CNN)Almost four weeks after the first American was vaccinated against the coronavirus, around 6 million people have received one of the shots — far below the US target, set last year, of 20 million by the end of 2020, according to the US Centers for Disease Control and Prevention.

As of Thursday, 5.9 million people had received a vaccination, up from 5.3 the day before, the CDC said. The US surgeon general said this week the United States is averaging about half a million vaccinations a day.While the target of 20 million may have been too high to begin with, the holidays may have caused delays, some health experts said, and there may be a time lag in reporting vaccinations.”It got off to a slow start and we need to do better at every level, but I believe that we will pick up momentum as we get beyond the holiday season into the first couple of weeks in January,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Newsday’s Randi Marshall this week in a virtual event.As 'messy' rollout continues, states begin to prioritize more people for vaccinationAs 'messy' rollout continues, states begin to prioritize more people for vaccinationAs 'messy' rollout continues, states begin to prioritize more people for vaccinationFauci warned against jumping to conclusions about the pace of the vaccine rollout in such a short time period, saying “we just started.”Read MoreStill, though a lot of money and effort has been put into developing vaccines and into distributing it to the states, less seems to have been put into how to actually get them administered, public health experts said. “There seems to have been the notion in Washington that, gee, you have all these public health people out there. All you have to do is send the vaccine out,” said William Schaffner, professor of infectious diseases at Vanderbilt University.”I’m having flashbacks to what happened with testing,” said Dr. Leana Wen, a visiting professor of health policy and management at the George Washington University’s Milken School of Public Health and a CNN medical analyst. “It’s the same thing, that initially there were promises made that were based on rosy projections. Everybody assumed that there was a national strategy when, as it turns out, there was not.” As year-end approaches, vaccine rollout remains woefully behind scheduleAs year-end approaches, vaccine rollout remains woefully behind scheduleAs year-end approaches, vaccine rollout remains woefully behind scheduleState and local health departments are already overstretched and “have not had the resources they need to plan and roll out the most ambitious vaccination program that our country has ever undertaken,” Wen said. Those departments “have been running all the other aspects of pandemic operations like testing, contact tracing, public education, data tracking, and now you’re adding to this responsibility this huge responsibility, and so they’ve been saying for months that they need additional support.”Added to that is the fact that the “public health infrastructure in the United States has been shrinking for about 15-20 years,” Schaffner said.How to ramp up vaccinationsThe federal government can do several things to speed up the vaccination process, Wen said, including instilling a sense of urgency and “(making) it clear that this is a wartime mobilization. That requires a national effort that’s 24/7, no excuses there.”Schaffner agreed.”You can vaccinate on Saturdays, you can vaccinate on Sundays, you can start at 6 o’clock in the morning,” Schaffner said. “You can go until 8 or 9 o’clock at night. So, the more you can vaccinate, the better.”Second, Wen said, the government could set targets, determine what state and local officials need to meet the targets, and help them get what they need.And the government could help with streamlining the process, staffing vaccination centers and setting up mass vaccination sites.”Everything that can be done by the federal government they should do, specifically staffing,” Wen said. “Why should 50 states be trying to figure out how they should all recruit vaccinators?”Mass immunization clinics — in parking lots, for example — would be one way to eventually pick up the speed in getting everyone inoculated, said L.J Tan, the chief strategy officer at the Immunization Action Coalition, which works to increase immunization rates. With flu, “we know if you do a really well-done mass immunization clinic, you can easily clear 20,000 vaccines a day,” Tan said. The rate for the coronavirus vaccine wouldn’t be as high because of the wait time required after giving the vaccine to make sure there’s no allergic reaction, he said.Hesitancy among health care workersSome states have been grappling with the reluctance of even health care workers to get vaccinated. In Texas, the Houston Methodist hospital system is offering a $500 bonus to workers if they get the coronavirus vaccine.But the real key to solving the problem, Schaffner said, is communication.’There has been an underappreciation of how much work in communication it’s going to take to bring people who are hesitant into the fold and get them vaccinated,” Schaffner said. “Even my good friends and dear friends at the CDC have profoundly underestimated the degree of vaccine hesitancy among people who work in the health care environment.”Sensing that that would be a problem, the Vanderbilt University Medical Center started an educational program four to six weeks before the vaccine was delivered, Schaffner said, including videos, social media and Q&A sessions.”We could see the proverbial needle move in the direction of acceptance,” Schaffner said.In Kentucky, “more than 30% of people eligible decline to receive the vaccine when offered” in some cases, the state’s health commissioner said Thursday. In nursing homes, there are reports that nursing aides — not the residents — are hesitant to be vaccinated, Tan said.”We need to figure out ways to go in and help them and help educate the nursing aides,” Tan said. “This is a safe and efficacious vaccine.”Part of the reason the rollout has been slow has to do with the population recommended to be the first to receive the vaccine: the elderly in long-term care facilities and health care workers, Tan said. In places like California, for example, where virus cases are soaring and hospitalization rates are overwhelming, facilities are judicious in giving the shots to heath care workers who may then develop a fever — one of the possible side effects of the vaccine, but also a Covid-19 symptom — which would keep them from work, if even for a short time, when hospitals need all the help they can get. “You can imagine that health care systems, with the surge of patients and needing full availability of their staff, are going to be a lot more deliberate with the way they vaccinate their staff,” Tan said. “You’re not going to vaccinate all of them at the same time,” or even half of them at the same time.’Just need to get it rolling,’ surgeon general saysUS Surgeon General Dr. Jerome Adams has been telling states to move on to the next priority group in line for vaccinations if their supply exceeds the demand among the people in the first phase, saying in a tweet Thursday that the CDC’s guidance is “recommendations — not mandates.”Florida seniors face long lines and a haphazard registration system to get Covid-19 vaccinesFlorida seniors face long lines and a haphazard registration system to get Covid-19 vaccinesFlorida seniors face long lines and a haphazard registration system to get Covid-19 vaccines“Get those vaccines where they’re going to be taken up,” Adams told NBC’s “Today” on Tuesday. “We don’t need to re-create the wheel, we just need to get it rolling.”Some states have begun moving even faster to expand the pool of those eligible for a vaccine, but that has created its own problems. In Florida, after those 65 and older were allowed to get the shot, people lined up for hours and the supply was quickly used up.President-elect Joe Biden has set an aggressive goal of 100 million shots in his first 100 days in office. That would vaccinate 50 million people, because immunization requires two separate doses for each person.Biden will aim to release nearly every available dose of vaccine when he takes office, according to TJ Ducklo, a spokesman for Biden’s transition.That’s a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.Though that’s a risky strategy, given that both vaccines now approved in the US require two doses, administered at specific intervals, a transition official said the Biden team believes that vaccine manufacturers will be able to produce enough second doses in time; Biden’s team plans to use the Defense Production Act to produce vaccine and other materials. Biden has said he would set up federally run and supported vaccination centers around the country with the help of the Federal Emergency Management Administration, the CDC, the military and the National Guard.

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