It wasn't long before Keith Reed, an assistant health commissioner in Oklahoma, discovered a major logistical problem with the introduction of state vaccination. Week after week, Oklahoma allocated thousands of valuable doses to a federal program for nursing home patients who did not all use them. Indeed, Tens of thousands of cans sat untouched in freezers.
So his department rang an acoustic signal. It was decided to stop allocating Oklahoma vaccines for the federal program, a partnership with private pharmacies like CVS and Walgreens to immunize residents of long-term care facilities. Instead, they would go to distribution channels that would get them into people's arms faster.
A number of states have taken similar steps to divert care from federal efforts known as the Pharmacy Partnership for Long-Term Care Program. This is a vivid example of how chaotic the US vaccination effort has been. Some of the other states are Minnesota, Maine, Michigan, Missouri, and Ohio.
Reed said moving to Oklahoma would do no harm: Walgreens and CVS have assured him that all nursing home residents in the state who needed and wanted to be vaccinated would have the first of their two shots by the end of the week.
The federal program used a formula that made it clear how many shots would be required for long-term care facilities like nursing homes, whose residents are particularly susceptible to the coronavirus. Another problem has arisen: a significant number of residents, and particularly workers in the facilities, are reluctant to be vaccinated.
A study published Monday by the Centers for Disease Control and Prevention found that 77.8 percent of residents and 37.5 percent of workers received the vaccine in an average long-term care facility in the first month of the program. The study says the real rate may be higher for workers as some may have been vaccinated in different settings. Even so, federal officials are particularly concerned about how many workers oppose vaccination and have stepped up efforts to change their minds.
Mr Reed said the doses Oklahoma took away from the federal program will go to thousands of Oklahomans who are 65 years or older and do not live in nursing homes.
"Our goal is to get the vaccine into someone else's arms within seven days of receiving it from the freezer," Reed said in an interview last week. "We just had a tough time with this amount of vaccines that were earmarked for this program when we could use this vaccine to go straight to Oklahomans."
Nursing home residents' advocates are watching closely for signs that the moves will hamper their vaccinations.
"If we find older adults are not getting the vaccines they need, that's our business," said Lisa Sanders, a spokeswoman for LeadingAge, which represents more than 5,000 nonprofit aging service providers.