Three weeks after the federal government approved the latest Covid-19 Vaccine, the rollout has been rocky.

Even as the number of cases climb, delayed vaccine deliveries are being reported by CVS, Walgreens, Kaiser, long-term care facilities and other providers, causing consumers to wait for appointments.

“There are supply issues,” said Los Altos geriatric specialist Dr. Mehrdad Ayati. “We have a backorder situation.”

For patients under age 12, the vaccine is not available yet. Manufacturers and distributors got out the adult Vaccines first, CDC director Mandy Cohen told reporters last week. Pediatric vaccines require different dose sizes and packaging.

The CDC recommended on Sept. 12 that everyone ages 6 months and older get an updated vaccine, after the shots were cleared by the Food and Drug Administration.The reformulated shot, developed by Pfizer and Moderna, can better help fight off infection because it is designed to protect against the variant XBB.1.5, a recent descendant of the Omicron variant that emerged earlier this year and is driving a new spike in cases.

While 73% of Californians received the two-dose “primary series” of vaccines, only 21.5% are up to date with boosters, according to the California Department of Public Health.

One vaccines were developed, less than a year into the pandemic, Americans didn’t need to worry about getting access to supplies. But the federal government ended its coverage of that service earlier this year after the public health emergency ended, when cases dropped and funding dried up.

The complex business of vaccination distribution then shifted to the private market.

Now manufacturers no longer ship doses directly to massive vaccination centers, but instead send them to wholesalers that distribute doses to a wide array of vaccination sites.  The single-payer program has been replaced by a system where a variety of private and public insurers cover the cost.

“The fall COVID-19 vaccine rollout is a mess right now. This is due to a massive shift: vaccines are now commercialized,” wrote Katelyn Jetelina, an epidemiologist and data scientist with the University of Texas Health Science Center at Houston.

During the frantic early days of the pandemic, Gus Perna— a four-star general and chief operations officer of “Operation Warp Speed,” the program launched by the Trump administration to fast-track development, production and distribution of COVID vaccines – led the fast, equitable and smooth distribution of vaccines to the entire nation, she said.

“We knew that transitioning from government purchase of COVID vaccines to the commercial market was going to lead to much higher prices,” according to Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “Less apparent were the glitches that would result from the lack of doses being purchased by pharmacies and confusion over insurance coverage.”

John Brownstein, chief innovation officer at Boston Children’s Hospital, who led development of the vaccines.gov website, told STAT, a health website, that “we got spoiled in terms of vaccine access. … When the government is not footing the bill, it’s harder.”

Consumers who seek a vaccine can get one from their health care provider or make an appointment at Walgreens, CVS or Safeway and pay out of pocket. But available appointment slots are several days, even weeks, away.  Some appointments may need to be rescheduled if vaccine supplies far short.

Palo Alto resident Larry Chickering first tried CVS. “Online scheduling is awful,” he said. “So I tried Safeway and all worked out well….I had a good experience.”

In an apology to customers, CVS said its pharmacies were receiving vaccines from suppliers on a rolling basis and most of its locations can honor scheduled appointments. “However, due to delivery delays from our wholesalers, some appointments may be rescheduled,” according to its written statement.

Walgreens said it is working closely with its distributor to improve supplies. “As additional inventory arrives to our stores, appointments will be added,” it said.

At Kaiser, appointments aren’t available, but the vaccine is available on a walk-in basis: first-come, first-service.

“I went with my 94-year-old father yesterday. Kaiser Mountain View told us it would be at least a two-hour wait so we drove to Kaiser Redwood City and stood in line for an hour before leaving,” said Carine Schneider of Menlo Park. “There were at least 50 people ahead of us in a line that was moving slowly. They are not allowing appointments like last year, and it was too much for someone at that age.”

Despite a wait, Naomi Goodman of Menlo Park succeeded in getting both COVID and flu vaccines in Kaiser Redwood City.  “The wait was about an hour, but the line moved quickly and they seemed to have plenty of supply,” she said. “The staff were very attentive to elderly people while I was waiting, allowing them to sit in the cardiology reception area until their place in line arrived.”

According to Kaiser, “since the FDA authorized the updated vaccine, large-scale distribution has been a challenge for vaccine providers nationwide, including Kaiser Permanente. However, we have now received our supply and expect a consistent supply of the vaccine going forward.”

Under the provisions of the Affordable Care Act, private insurers such as Kaiser are paying the full cost of vaccine doses.

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Those without private insurance are eligible for free shots through Medicare, Medicaid, or through a new program, Bridge Access Program, operated by the CDC. Children whose parents lack insurance coverage can get shots through CDC’s Vaccines for Children program.

If you have insurance that does not include CVS or Walgreens as an “in-network pharmacy,” you may be charged up to $200 for the vaccination.

Distribution problems should be worked out within the next several weeks, said Elizabeth Sobczyk, project director of Moving Needles, a CDC-funded initiative to improve adult immunization rates in long-term care facilities. “This timeline is consistent with other newly recommended commercial vaccines,” she said.

“We recognize the frustration,”  she said. “But we also know this is the first time COVID-19 vaccine has rolled out as a commercialized product.”