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Early Challenges Highlight Areas for Improvement in COVID-19 Vaccination Programs


State and local immunization programs distributing COVID-19 vaccines faced numerous challenges including (1) achieving logistical efficiency; (2) obtaining complete vaccine data from providers; (3) combating vaccine hesitancy with public health messaging; and (4) overseeing vaccine providers.


Vaccines help reduce disease-related illnesses, hospitalizations, and deaths. The Centers for Disease Control and Prevention (CDC) assists and funds State and local immunization programs—to which we refer as awardees—to support vaccine programs that immunize individuals in their jurisdictions against vaccine-preventable diseases (e.g., measles and influenza). CDC's COVID-19 vaccination program is an extension of these efforts. As vaccine supply increased in March 2021—during the early stages of COVID-19 vaccination programs—awardees faced challenges in meeting their goals of immunizing the U.S. population amid an ongoing pandemic.

As CDC makes ongoing program improvements, it can be assisted by understanding the challenges that awardees experienced with the COVID 19 vaccination program and the mitigation strategies they took. This understanding can also help CDC enhance routine immunization programs and better prepare for vaccination programs for future pandemics.


The Office of Inspector General (OIG) collected data on the challenges and mitigation strategies that 56 State and large metropolitan area awardees reported in March 2021. We also interviewed CDC, officials from other Department of Health and Human Services (HHS) agencies, and other Federal officials, and we reviewed written responses and documentation across HHS. To support ongoing vaccination efforts, OIG shared preliminary analysis with CDC in late March and early April 2021.


In the early stages of their COVID-19 vaccination programs, awardees consistently reported challenges that affected their ability to administer COVID-19 vaccines efficiently and equitably. Specifically, awardees reported logistical challenges that impacted efficiency, including large minimum order sizes for vaccines, requirements for ultra-cold storage, and insufficient ancillary supplies. Additionally, awardees reported challenges in obtaining complete, timely, and accurate vaccine data both from Federal program and from jurisdictional providers, which affected their ability to determine community needs efficiently and equitably. Finally, awardees also reported wanting more Federal Government support for public health messaging and for their oversight of providers.

For each type of challenge, awardees also reported using a variety of strategies to mitigate the challenge. For example, awardees reported breaking down large minimum order sizes to improve vaccine access. Awardees also reported having less experienced providers shadow each other to improve provider understanding of data systems.


COVID-19 vaccination efforts are ongoing, and CDC continues to take steps to address many awardee challenges. However, areas for improving the efficiency and equity of the vaccination program remain. Specifically, OIG recommends that CDC update its plans for mass vaccination programs with strategies that address awardee-reported logistical challenges and strengthen reporting of vaccine allocation data and administration data. In addition, OIG recommends that CDC clarify roles and responsibilities within HHS for vaccine public health messaging during a pandemic. Finally, OIG recommends that CDC work with awardees to enhance current and future capabilities for provider training and oversight. CDC concurred with all four recommendations.