What is actually needed for large-scale vaccinations? The current strategy allows for every clinic, hospital and pharmacy to be a vaccination site, which translates into tens of thousands, if not hundreds of thousands, of sites across the nation. It would be simpler and easier to take a more streamlined approach, with the federal government working with states to focus resources on a more limited number of sites, providing more direct logistical support to each instead of leaving them to fend for themselves. Among other things, this would mean ensuring that they had the physical infrastructure, the staffing and the IT infrastructure they need to proceed. For people who are not able to go to these sites (such as some nursing home residents), local pharmacies could deliver the shots. (West Virginia took this approach, becoming the first in the nation to offer vaccines to all nursing home residents.) Some states might choose a different approach, and the federal government could work with them.

Regardless of the particular approach, this sort of planning should have happened in October and November. The administration should have gone to Congress and gotten the money needed to set this up. That didn’t happen. Instead, the administration is blaming the states. Of course, once a blame culture is set, the finger-pointing continues: In Mississippi, the health chief says it’s not the state’s job to ensure vaccines get into people’s arms and he is now blaming front-line providers for the slow rollout.