Hawaii is lagging in rolling out COVID-19 vaccines, falling to 44th nationwide on Wednesday as health officials struggle with capacity and uncertainty surrounding the federal delivery of more doses.

Data from the U.S. Centers for Disease Control and Prevention shows more than 154,000 doses have been shipped to Hawaii, but just over 36,000 have been administered. The Hawaii Department of Health says it has received about 109,000 and administered more than 40,000 — a figure that has not yet been reflected in the federal system.

Those involved in the state’s vaccination effort say the pace is expected to pick up, especially with the establishment of two mass vaccination centers on Oahu, including one opening Monday at the Honolulu Harbor’s Pier 2 Passenger Terminal.

But limited space in the health care systems and difficulties in identifying and coordinating with members of priority groups have slowed the operation since the state received its first batch of vaccines on Dec. 14.

Health officials also spoke of uncertainties about how many and when doses will arrive from the federal government, which has made scheduling and staffing challenging.

“We are doing our best to anticipate what we will actually receive and how we can effectively get them out to the community,” Lt. Gov. Josh Green, Hawaii’s COVID-19 Liaison, said.

House Speaker Scott Saiki said the state health department took unnecessarily long to set up the mass vaccination centers — a deal he and others helped broker between the state and private health networks.

“The longer the DOH drags its feet, the more Hawaii people get sick and die,” he said.

Hawaii Department of Health spokesman Brooks Baehr said at a press conference Wednesday that more doses have been administered than data — even the 40,386 shown on the state’s dashboard — reflect. “I can stand here and promise you there are many more than that,” he told reporters.

The department anticipates the pace to accelerate in the coming weeks, he added in an email, but did not elaborate how.

Hawaii is prioritizing health care workers, long-term care facility residents, essential workers and seniors in the early stages of a global campaign to vaccinate millions of people against the coronavirus.

The state has set up vaccination hubs in each county, which includes major hospitals across the isles. Officials also announced with fanfare plans for the two mass vaccination centers on Oahu, but those were established by Hawaii Pacific Health and Queen’s Health Systems — not the health department.

“It’s troubling that the health department didn’t take the initiative,” Saiki said. “They knew there would be a need, and they didn’t have a plan.”

CDC’s data is updated daily, whereas the state’s vaccine tracker, which shows 40,386 doses had been administered as of Wednesday, is updated weekly. The state data shows nearly 25,613 of those went to Honolulu.

The federal data also calculates vaccine administration rates per capita using population counts from the U.S. Census Bureau. That ranked Hawaii at No. 44 among states, territories and federal entities on Wednesday, with 2,585 per 100,000 people vaccinated.

The jurisdiction that has the highest COVID-19 vaccine administration rate per 100,000 people is the Northern Mariana Islands, at 7,280.

The commonwealth set up a website — Vaccinate CNMI — for people to register online for vaccinations and operates a call center to answer questions. Gov. Ralph Torres credited maximizing existing health resources, as well as proactively procuring new equipment necessary for vaccine administration.

Logistical Challenges

Part of the challenge in administering the vaccinations faster has been having a space big enough to serve thousands of people a day, while allowing them to stay 6 feet apart, said Ray Vara, Hawaii Pacific Health’s chief executive.

In addition to space, he said, there’s a need for other features, like robust internet access, air conditioning and access to parking.

Hawaii Pacific Health has been giving shots to its employees and other health care professionals who are part of the first phase eligible for vaccines, Vara said. But it also has 20,000 vaccines ready to roll out over the next two weeks as the facility gets up and running.

“We have 20,000 sitting in freezers to use at this site,” he said. He added that Hawaii Pacific Health is already scheduling appointments through its website.

Vara and Queen’s chief executive, Dr. Jill Hoggard Green, said the two facilities combined have a goal of processing as many as 10,000 shots per day. But Green said it will take time to gear up to capacity.

“That would be our goal,” she said. “But it will take staging.”

For example, she said officials expected to begin with about 2,000 per day at the Blaisdell Concert Center on Monday, then advance to 3,000 to 4,000 in coming weeks.

The health department foresaw some of these challenges. In a December informational briefing, officials and others involved in the effort said staffing needs, demand for supplies, storage issues and vaccine skepticism, among other issues, could complicate the rollout.

“The hardest part is actually getting shots in arms,” Jon Shear, CEO of ReadyZoneHQ, an emergency management company workin“g with DOH on the vaccination effort, said at the meeting.

A lot of coordination has to happen before people can actually receive the shots, including allocation of the doses, scheduling and arranging for adequate staffing, he said.

Steve Lane, 78, has not been able to get a vaccine even though he is in the priority category under the state’s plan.

“I’ve been waiting for as long as everybody else,” the Manoa resident said. Straub, his health care provider, announced people who qualify can get vaccinated early next week, but he can’t find a way to sign up yet, he added.

At the same time, he’s seen and heard of numerous other people living in different areas of town, including some who may be lower in priority, having been vaccinated.

For example, Adventist Health Castle and Maui Memorial Health Center jumped ahead to vaccinate kupuna over the age of 75 before plans to vaccinate that group were finalized.

“There doesn’t appear to be any coordinated effort despite all the press conferences on an hourly basis,” he said in a phone interview.

“We’ve got more than 400,000 dead Americans. Nobody wants to be included in that category. This is a public health catastrophe,” he added.

Pace Will Pick Up

The lieutenant governor said some Oahu hospitals have started administering vaccines to the second tier of people, including those 75 and older.

Kaiser Permanente has been giving out 1,000 a day and expects to administer 2,200 on Monday, Green said. Castle Memorial Hospital is administering 1,200 per day, Green said.

Despite criticizing the health department for not being more proactive, the House speaker said the mass vaccination centers and the collaborative effort that it took to set them up should help speed things up.

Saiki praised the department, the private hospitals, Honolulu Mayor Rick Blangiardi and fellow lawmakers who helped him, Rep. Linda Ichiyama and Rep. Aaron Ling Johansson for getting the centers set up.

He called the centers “emblematic of how government needs to work in the future — just roll up our sleeves and get it done.”

Saiki said he and fellow House members began working on the project just before the new year after being contacted by Vara.

While the past two weeks were marked by a sense of urgency by Saiki and Vara particularly, Ichiyama said the project had come together relatively quickly, considering it involves not just two private hospitals, but also state and local governments, and complicated contracts and leases.

“It was a pretty quick turnaround,” she said. “It was fast for us.”

The facilities located at the Blaisdell Center and the Pier 2 Passenger Terminal are being set up under a public private partnership between the Hawaii Department of Health, The Queen’s Medical Center and Hawaii Pacific Health, which operates numerous medical facilities on Oahu.

The facilities will operate six days a week, and the Pier 2 facility will be able to administer an estimated 10,000 vaccines per day, Saiki said.