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The parking lot at Disneyland in Southern California has been converted into a COVID-19 vaccination site. Jeff Gritchen/MediaNews Group/Orange County Register via Getty Images
  • The distribution of COVID-19 vaccines is being expanded across the country after a slow initial rollout.
  • The Centers for Disease Control and Prevention (CDC) has recently changed its guidelines to allow everyone 65 years and older to be eligible for vaccination.
  • Some states are establishing clinics at large venues such as Disneyland and Dodger Stadium in California to meet demand.

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The rollout of the COVID-19 vaccine in the United States remains a fractured and slow process, leaving many people wondering when they’ll be able to get their first and second shots.

There have been reports of people getting the vaccine simply because they were in the right place at the right time, as health officials needed to distribute doses before they went bad.

There are even people who received vaccinations because the vials carried more than enough to inoculate one person.

New York Gov. Andrew Cuomo had threatened to fine healthcare providers if they gave vaccine doses to ineligible recipients ahead of schedule, but this month he threatened to fine hospitals if they didn’t give out the shots quickly enough.

It’s the latest in a long and confusing line of deciding who gets COVID-19 vaccinations first and where they line up to get the vaccine.

Though people are used to getting vaccines in their doctor’s office or a flu shot at their local pharmacy, there’s an increasingly likely chance most Americans will get their COVID-19 vaccine at a mass site, such as a baseball or football stadium, or even the “happiest place on earth.”

As the vaccine allows people a chance to possibly regain normalcy to their lives, getting their two doses of the available vaccines is on the top of many people’s minds, whether they’re frontline healthcare workers or those hoping to reopen their businesses after months of health-related shutdowns.

But much like everything related to the novel coronavirus in the past year, expect that things can change quickly with a lot of confusion in the mix.

According to the guidelines established by the Centers for Disease Control and Prevention (CDC), the first priority in COVID-19 vaccine distribution has been frontline healthcare workers, including those in hospitals and EMS personnel as well as those who work in skilled nursing facilities.

As of Friday, Jan. 15, more than 31 million doses of the vaccine have been distributed in the United States, and more than 12 million people have received their first of two COVID-19 vaccine shots.

Federal officials have since expanded those guidelines to include people age 65 and older and people with serious underlying medical conditions, resulting in a barrage of phone calls to health departments and healthcare providers from those wondering when and where they can get their shots.

That’s resulted in people waiting hours on hold as they contact their healthcare providers to reserve their spot in line.

“COVID vaccines are a very complex topic. And the answers vary depending on where you are because local health departments are the primary agency for administering public health actions like vaccines,” said Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California.

Following healthcare workers and long-term care facility residents, the CDC guidelines say frontline essential workers and people age 65 years and older are next.

People over the age of 16 with underlying medical conditions and other essential workers will follow.

Once those people are inoculated, the vaccine should be available to everyone else.

But those are only guidelines.

As with most other pandemic-related issues so far, states — not the federal government — are primarily responsible for distributing vaccinations to healthcare workers so they can inoculate people. Even then, that is fragmented and even fractured.

California has county-by-county plans. Some officials have recently said they’re increasing efforts to get shots out to those currently eligible under CDC guidelines.

Those efforts include turning large sports venues — such as Dodger Stadium in Los Angeles and the Coliseum in Oakland — into mass vaccination sites. Even Disneyland parking lots are being used for people who are ready and eligible for vaccinations.

These sites are popping up to help deal with the difficulties of keeping the vaccines cold enough until they’re ready to go into someone’s arms.

“The logistical hurdles of creating large vaccine administration sites like Dodger Stadium and Disneyland are immense,” Cutler told Healthline. “The present vaccines must be thawed, mixed, drawn into syringes, injected, documented, patients identified, registered, observed for adverse reactions, and signed up for their second shots.”

From production to distribution, the COVID-19 vaccine rollout is proving to be a logistical nightmare.

“Even at that high rate, it will still take about nine months to get the whole U.S. population vaccinated. This has never been done before,” Cutler said. “It is a massive, complex, and risky undertaking as a small number of people will have serious adverse reactions. But thousands each day are dying, so it is critical to get this done as soon as possible.”

The federal government’s Operation Warp Speed has promised to produce and deliver 300 million doses of COVID-19 vaccines by this month, but state leaders are finding major glitches in those plans.

Oregon Gov. Kate Brown tweeted Friday, Jan. 15, that Gen. Gustave F. Perna, head of Operation Warp Speed, confirmed that states would not be receiving increased shipments of vaccines from the national stockpile because the federal government doesn’t have a reserve of doses.

“I am demanding answers from the Trump administration. I am shocked and appalled that they have set an expectation on which they could not deliver, with such grave consequences,” Brown tweeted. “This is a deception on a national scale. Oregon’s seniors, teachers, all of us, were depending on the promise of Oregon’s share of the federal reserve of vaccines being released to us.”

Dr. Jagdish Khubchandani, a professor of public health at New Mexico State University, and his colleagues recently wrote in the International Journal of Environmental Research and Public Health about some of the “Ps” that affect the course of a pandemic.

These include poverty, population and people culture, policies and politics, primary care and providers, publicity and panic, prices and payers, and pharmaceuticals and productions.

One of the most important ones, they wrote, is preparedness. And the U.S. healthcare system is and was not ready for the novel coronavirus due to a lack of providers, places, and preparedness.

“We are mostly underprepared,” Khubchandani told Healthline. “We never valued or invested in frontline and community health workers, and now we ask them to vaccinate millions of people in open spaces like stadiums without even a snack.”

But one major issue plaguing vaccine distribution is the number of people willing to get their shots.

Early on, large percentages of people polled said they’d refused to get the vaccine for fear it was rushed through the approval process or because of a general lack of trust in vaccines. But those numbers are changing as the vaccine reaches more people experiencing fewer reported serious side effects.

A Kaiser Family Foundation poll in December found that a third of the public would get the vaccine “as soon as possible,” while nearly 40 percent have a “wait and see” approach.

Also, a Pew Research poll found that 60 percent of people now intend to get a COVID-19 vaccination as confidence in the research and development process increases.

Experts say it’ll take about 70 percent of the population to be vaccinated to protect everyone else fully.

“We rely on enough people being vaccinated so that if disease does occur, there aren’t enough people around who are susceptible to pass the disease on and create a wider outbreak,” Cutler said. “While it is important to understand where you stand in line for getting the vaccine, it is more important to stay protected before and even after you receive the vaccine. No vaccine is 100 percent effective, and it may be possible to transmit the virus even if you don’t get sick.”

Khubchandani recommends that people register now to get their vaccination appointments if they are eligible.

He says creating an us-versus-COVID mentality can go a long way, especially if people are given something as simple as a sticker similar to “I voted” to show they’ve received their vaccines.

Even then, it’s going to take a lot more to get people vaccinated before the COVID-19 pandemic is over.

“It is not going to be a single strategy, as hardly any interventions have shown major success in reducing vaccine hesitancy,” Khubchandani said.