King County, which represents greater Seattle, has $14 million of COVID-19 funding for 2021, roughly enough to fund its operations for a single month, and a fraction of the $87 million emergency COVID-19 aid it received in 2020, said Ingrid Ulrey, the public health policy director for King County. “We’ve been on pins and needles the whole last three or four months, watching what’s happening at the federal level, waiting, watching,” she said. When newly approved federal funds finally trickle down to her level, she expects them to be less than this year, insufficient and too late. “It’s shockingly low,” she added. “We have a huge new, unprecedented, daunting task of vaccine delivery.” King County is at risk of being unable to hire the up to 40 additional staff needed to begin the next wave of public vaccinations. In counties across the United States, the funding crisis has limited the hiring of needed vaccine staff, delayed the creation of vaccination centers, and undermined efforts to raise public awareness, officials told Reuters.

The federal government spent more than $10 billion to speed COVID-19 vaccine development but has so far disbursed little funding for distribution, even as it pushed the responsibility of actual immunizations onto state and local governments. A new $2.3 trillion pandemic aid and spending package provides $8.75 billion to states to assist in vaccinations, in line with what state and local officials had requested, but months after distribution work should have begun. “The Federal Government has distributed the vaccines to the states. Now it is up to the states to administer. Get moving!” U.S. President Donald Trump tweeted on Wednesday. The promised wave of newly approved vaccinations has been only a ripple: around 2.8 million Americans have received a shot, including fewer than 170,000 residents of nursing homes, one of the most at-risk groups, according to the Centers for Disease Control and Prevention (CDC). That is far fewer than the 20 million vaccinations the federal government promised for December. Nearly 10 million of the 12.4 million doses the government has distributed to states sit unused, and on Tuesday President-elect Joe Biden said it would take years, not months, to vaccinate most Americans at the current pace. Hospitals and pharmacies CVS and Walgreens are in charge of the first wave of vaccinations of health care workers and long-term care residents. But local health systems will take a leading role in immunizing the next, bigger waves, and will be critical for groups such as the uninsured, underinsured, homeless and others.