The U.S. enters 2021 playing catch-up with its vaccine distribution, prompting sharp words from Mitt Romney.

The United States begins the new year far behind schedule in its coronavirus vaccine rollout, having distributed shots to a mere fraction of the 20 million it had hoped to reach by this time, even as the nation hit a grim new milestone on New Year’s Eve: 20 million cases since the start of the pandemic.

In a statement uploaded to his website on Friday, Senator Mitt Romney of Utah said it was “as incomprehensible as it is inexcusable” that “comprehensive vaccination plans have not been developed at the federal level and sent to the states as models.”

The statement is the strongest criticism to date of the Trump administration’s handling of the vaccine rollout from a Republican senator.

According to the Centers for Disease Control and Prevention, about 2.8 million people have received their first dose, though that number may be somewhat low because of lags in reporting. Federal officials say they do not fully understand the cause of the delays and have denied that they are to blame. Officials behind Operation Warp Speed, the federal effort to fast-track vaccines, have said that their job is to ensure that vaccines are made available and get shipped out to the states. The states are then expected to carry the baton.

Mr. Romney called it “unrealistic to assume” that already overtaxed health care workers could take on the responsibility of vaccinating the nation, and criticized the plan to have CVS and Walgreens to carry out mass inoculations.

“They don’t have excess personnel available to inoculate millions of Americans,” Mr. Romney continued. “Nor are they equipped to deal with the rare but serious reactions which may occur.”

Mr. Romney offered several loose ideas, such as training every otherwise unoccupied medical professional, retired or active, to administer vaccines and establishing a schedule based on a patient’s priority category and birth date.

“I have experience organizing a major logistical event but nothing on the scale of what is called for today,” Mr. Romney added. “Nor do I have any relevant medical or public health experience. But I know that when something isn’t working, you need to acknowledge reality and develop a plan — particularly when hundreds of thousands of lives are at stake.”

Health officials and hospital leaders throughout the country have pointed to several factors for lags in the vaccination campaign.

People have been off work and clinics have had reduced hours during the holidays. States have held back doses to be given out to their nursing homes and other long-term care facilities, an effort that is just gearing up and expected to take several months. Across the country, just 8 percent of the doses distributed for use in these facilities have been administered, with two million yet to be given.

The rollout has been marked not only by delays, but by confusion, blunders and worse.

In one case, 42 people in West Virginia who were scheduled to receive the coronavirus vaccine on Wednesday were instead mistakenly injected with an experimental monoclonal antibody treatment.

In another, a pharmacist at a Wisconsin hospital was arrested for allegedly removing hundreds of vaccine doses from refrigeration, intentionally spoiling them. No motive has yet been specified, but officials said that the pharmacist knew that the his action would mean that people who received the ruined doses would think they were protected when they weren’t.

The United States is not alone in stumbling to distribute vaccines. President Emmanuel Macron of France faces growing criticism for the sluggishness of France’s rollout. Fewer than 200 people have received doses there since Sunday, when the European Union officially began its campaign to distribute shots to its 410 million citizens. Germany has inoculated nearly 80,000 over the same period.

By contrast, the pace of Israel’s vaccination program is far outstripping the rest of the world. Nearly 10 percent of Israel’s population has received the first of two doses of the Pfizer/BioNTech vaccine after the program began there on Dec. 20.

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