President Trump’s health leaders, racing toward the exits after their boss incited an end-of-term insurrection at the Capitol, acted to sow their own destructive confusion.

They left the incoming Biden Administration with new fury and frustration surrounding the efforts to get hundreds of millions vaccinated against the increasingly deadly coronavirus.

This wasn’t a juvenile prank like pulling “w” keys off White House computers. It was yet another incomprehensible bungle in what has been a shambolic federal response to the pandemic. It occurred as the nation keeps shattering records for coronavirus deaths, infections, and hospitalizations. As CNN reported:

“The U.S. has counted more Covid-19 deaths these last two weeks than any other 14-day stretch of the pandemic. And at this rate, the nation’s overall coronavirus death toll may hit 400,000 before President-elect Joe Biden is sworn in …”

Public health officials warned that vaccination and other preventive steps — including distancing, hygiene (especially hand washing), face covering, and avoiding of closed, poorly ventilated areas — require redoubled efforts as B.1.1.7, a highly contagious viral variant first identified in Britain sweeps the globe and may become the leading coronavirus threat.

Here is what the New York Times quoted Dr. Jay Butler, deputy director for infectious diseases at the federal Centers for Disease Control and Prevention, as saying:

“I want to stress that we are deeply concerned that this strain is more transmissible and can accelerate outbreaks in the U.S. in the coming weeks. We’re sounding the alarm and urging people to realize the pandemic is not over and in no way is it time to throw in the towel. We know what works and we know what to do.”

Dr. Ashish K. Jha, dean of Brown University’s School of Public Health, told the newspaper this:

“I see the new strain as a threat multiplied. Take everything we know about the risk of this virus and just multiply it substantially.”

But one of the most important ways to battle the coronavirus — inoculation of Americans with what has proved so far to be safe and effective vaccines developed in record time — has turned into disarray.

Azar creates vaccination confusion

Alex Azar, the exiting head of the Health and Human Services agency, had joined other Trump officials in over-promising and under-delivering on a crucial part of the vaccination effort. Not in the product’s speedy and applause-worthy development. Not in getting the fussy vaccines, which required cold or super cold storage, from coast-to-coast. No, news reports say that the officials of Operation Warp Speed, notably Azar, ignored or squatted on vital, “last mile” elements of a consequential public health campaign.

They failed, miserably, to reach out to the public to explain their plans, and, more importantly, to deal with vaccine hesitancy — normal and extreme — with information campaigns on the products’ safety and effectiveness. They also shunned colleagues at the state and local level, withholding key planning and coordination efforts, as well as desperately needed financial and other resource support.

Azar fired a huge parting shot in his own foot — and at the vaccine campaign — with a mangled decision about vaccine availability and the federal government’s guidance on who now should be getting shots. Governors and others say he told them that the makers and the federal government had ample stores, enough of the vaccine that all Americans 65 and older should start getting vaccinated. He encouraged millions of Americans to clamor for details about the shots, when state and local officials were still uncertain about vaccine supplies and whether they would hold up, as previously promised, for health workers and the aged, sick, and injured in long-term care facilities. State officials said, “huh?” and inquired if makers would be able to meet demand so those vaccinated with a first dose would have the second when needed.

As older Americans and their loved ones barraged doctors, hospitals, health agencies, politicians, and online portals across the country about getting immunized with vaccine supplies not available, Azar and other administration officials raced backward. (They also were mindful, no doubt, of the lines and upset occurring in Florida, where the governor opened vaccination to his large 65 and older population with little planning). No, the makers and federal government did not have significant vaccine stores. Even as news reports suggested that the manufacturers are wrestling with challenges to meet demands for the vaccines, Azar and others in the government insisted that supplies are getting out, according to plan, and the exiting head of Operation Warp Speed said the vaccination effort was “working perfectly.”

For the record, the federal Centers for Disease Control and Prevention (CDC) reported on Jan. 15 that 31 million vaccine doses had been distributed and 12.2 million patients had received the first of two required doses. That is an increase over the previous, sluggish vaccination levels. It is far from the 20 million vaccinations that Trump officials said would occur by December’s end, though they now say they meant only that number of doses would be shipped, not that they would be administered.

Problems growing, too, in nursing home vaccinations

By the way, part of the back-and-forth about vaccine availability was rooted in earlier Trump officials’ plans to keep back stores to ensure that residents of nursing homes and other such facilities — hard hit by coronavirus deaths and infections — would be priority vaccination patients.

Anger has been rising, however, at the pokey progress with vaccinating staff and residents at long-term care facilities, especially with pharmacy giants Walgreens and CVS contracting to provide these shots in many areas. The CDC reporting of data in this area has changed in a week, so that the agency simply says that ~1.4 million doses have been given in long-term care facilities.

Depending on what facilities may be included and what kinds of residents and staff that may cover, that number may be lagging far behind, because federal officials earlier had reported that more than 8.3 million Americans may be in some form of long-term care (and that number does not include the staff who assist them and who need to be vaccinated to safeguard the vulnerable).

A change in administrations

What’s next?

The new folks will say adios to Azar, as well as the moniker Operation Warp Speed (fearing the name alone creates distrust in the vaccines safety and effectiveness). Biden, in a national address, has called for a $1.9 trillion pandemic response package, including a significant new federal plan and intervention in the vaccine effort. It will include outreach and information campaigns, as well as increased cooperation, coordination, and support between Washington and states and local governments with coronavirus testing, tracing, and vaccination. The new team will feature seasoned, respected, and familiar experts in medicine, public health, politics, and public policy. The new plans call for federal and military assistance in creating mass vaccination sites, as well as working with vaccine makers to determine choke points in their supply chains that prevent more supplies from getting delivered faster.

The new administration will wrestle with the reality that, absent a coherent federal role in the efforts to vaccinate patients, Americans — including seniors and others who may not have the cognitive capacity or online skills or connections to do so — may be running a maze of different vaccine plans, depending on the state, county, and even city.

Biden has said repeatedly that his administration’s goal is to get 100 million Americans vaccinated in his first 100 days in office.

Let’s see if he can accomplish that or anything close, especially given the obstacles thrown up by his departing predecessors.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles in normal times to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

At this time, we need to provide unstinting support to the health care system as it gets battered by the coronavirus and throngs of patients needing care. Patience will be required in the days ahead, as the public health experts advance toward their early vaccination goal — getting protected front-line health workers and vulnerable folks in long-term care facilities. The “surge upon surge” of coronavirus cases has not made it easy to vaccinate already overwhelmed health workers, whether in hospitals and clinics or in long-term care facilities. This phase was not well run, the visible evidence shows, and it may have been one of the less demanding because the groups targeted for vaccination were clear (they even have good ID and appear on HR lists!) and relatively contained.

As the population for vaccination expands, however, the challenges will, too. Exponentially. Will there be enough vaccine? How will patients be informed and reassured about the shots’ safety, effectiveness, and potential side effects? How will people make appointments for vaccination, and how will officials ensure the priority system is fair — and that it also gets desperately needed protection to those in great need, including seniors, essential workers, and communities of color savaged now by infections and deaths? Will the vaccination roll-out get rockier, with mass media carrying images of long lines of frustrated people waiting for shots, or with reports of rare reactions to the vaccine (these illnesses and even deaths may not prove to be inoculation caused)?

Biden and medical scientists have hastened to warn that the pandemic and the vaccination campaign all may get worse before they get better. This is no time to lose hope, nor to ease up the battle against the coronavirus. We have much work to do to get to a better place than we have been before.