U.S. health officials acknowledged that a Covid-19 immunization campaign is crawling out of the starting gate, raising the prospect that the nation’s all-in bet on vaccines could be afflicted by the same dysfunction that hobbled other measures to contain the pandemic.

Only about 3.05 million Americans had been vaccinated as of late Wednesday evening in New York, according to Bloomberg’s vaccine tracker. With one day remaining in the year, that represented roughly 15% of the U.S.’s stated goal of immunizing 20 million Americans by the end of 2020 -- a number already repeatedly reduced.

The task of delivering shots that could end a pandemic that has killed 341,000 U.S. residents is taxing a largely private medical system designed to maximize profit rather than deliver public health. Governments and institutions are struggling with complex logistics to keep the shots cold, organizing cohorts of people to receive them and persuading those made skeptical by a flood of online disinformation.

Robert Wachter, chairman of the department of medicine at the University of California, San Francisco, said the Trump administration is repeating its grave errors in providing tests and personal protective equipment.

“It’s another manifestation of a lack of a federal plan with appropriate resources. It’s the testing problem now just applied to a different setting. Not just testing but PPE,” Wachter said. “Each one of these has been sad. This one could be tragic. With each passing day, if vaccines are sitting on shelves waiting to be administered, those are people that will die because of that.”

Senior public-health officials said the vaccination pace will accelerate as soon as next week. Nursing homes and other long-term care facilities are likely to get more shots done as the new year dawns and the holidays recede, said Nancy Messonnier of the U.S. Centers for Disease Control and Prevention.

The leader of the logistics effort said that it will take time to understand why uptake has proceeded so slowly. “We developed and launched a new data system that connects hundreds of existing systems at the state and local level, to allow us to have visibility so that we can see ourselves across the entire United States,” said Army General Gustave Perna.

Meanwhile, states are improvising new delivery systems and rewriting priorities for who should get access to shots first.

Colorado on Wednesday said it would vaccinate people 70 and older, joining Texas and Florida in trying to quickly immunize older residents -- even though federal guidelines favor health-care workers. Other cities and states are just now registering recipients, weeks after the Trump administration made clear it considered its job done once vaccines were delivered to hospitals and agencies.

West Virginia finished giving the first of two required shots to residents and employees of long-term care facilities, the first state to do so, Governor Jim Justice said Wednesday. The state is now vaccinating prison guards and emergency workers, and then will target teachers and residents 80 and older, Justice said.

Julie Swann, a professor and supply-chain expert at North Carolina State University, said prioritizing groups for initial shots is an impediment. States are consciously weighing the competing values of protecting specific people, such as medical workers, against immunizing the general population as quickly as possible.

“We have multiple competing objectives, and it’s hard to satisfy them simultaneously,” Swann said.

Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, attributed the slow rollout to public health departments being strained by the pandemic, launching the inoculation campaign amid the holiday season and the Covid-19 vaccines’ special handling and storage requirements.

The formula created by Pfizer Inc. and BioNTech SE needs to be stored at 94 degrees below zero Fahrenheit. That makes the logistics more complicated than a simple flu shot, said Kris Ehresmann, infectious-disease director of the Minnesota Department of Health.

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