Logistical problems at the heart of the federal government’s faltering rollout of coronavirus vaccines came into sharper view Thursday as the Trump administration fell vastly short of its goal of delivering an initial shot to 20 million people by the end of December.

On the final day of a bleak year, only about 2.8 million people had received the shot, according to the Centers for Disease Control and Prevention — the first of two doses needed to provide immunity to the virus. Around 14 million doses had been distributed as of Wednesday, according to Gustave Perna, chief operating officer of Operation Warp Speed, and a total of 20 million doses have been allocated.

Though the figures are an underestimate — data collection on vaccinations has lagged — the doses administered so far represent just a small fraction of the ambitious targets outlined by officials from the administration’s Operation Warp Speed program in the fall.

“We’d have liked to have seen it run smoothly and have 20 million doses in to people today, by the end of 2020, which was the projection,” Anthony S. Fauci, the government’s leading infectious-disease expert, said in an interview with NBC’s “Today” show on Thursday. “Obviously it didn’t happen, and that’s disappointing.”

Here are some significant developments:

  • Forty-two people in West Virginia received an antibody treatment rather than Moderna’s coronavirus vaccine in an error Wednesday at a vaccination clinic hosted by a county health department.
  • President-elect Joe Biden’s inaugural committee will host a memorial honoring pandemic victims with a lighting around the Lincoln Memorial Reflecting Pool on Jan. 19, the day before his inauguration.
  • An employee at a hospital outside Milwaukee deliberately spoiled more than 500 doses of the coronavirus vaccine by removing 57 vials from a pharmacy refrigerator, hospital officials announced Wednesday, as local police said they were investigating the incident with the help of federal authorities.
  • Five days before a pivotal runoff election, Georgia Sen. David Perdue (R) is quarantining after coming into close contact with a member of his campaign staff who tested positive.
  • Medical centers in the United States are balking at providing monoclonal antibodies, the only treatment for covid-19 that aims to keep people out of the hospital, saying it presents major logistical challenges to staff already overburdened by vaccination efforts and surges in patients. The move leaves hundreds of thousands of doses of the medication unused.
  • Since Tuesday, three states have identified cases of a variant first detected in the United Kingdom, indicating its interstate spread in the United States. Florida Department of Health announced Thursday evening a man in his 20s in Martin Country with no recent travel history was believed to be infected with the highly infectious variant.

Nationwide, states and health-care providers continued to grapple with unpredictable timelines for when new vaccine shipments would arrive and in what quantities, while chronically underfunded public health departments struggled to muster the resources to carry out mass injections of front-line workers and vulnerable people.

Fauci said that he hoped momentum for vaccinations would build in the first weeks of the new year and bring the country closer to its immunization goals.

“But there really has to be more effort in the sense of resources for the locals, namely the states, the cities, the counties, the places where the vaccine is actually going into the arms of individuals,” he said. “We have to support the local groups, the states and the cities to help them get this task done, which is a very prodigious task.”

Under the Trump administration’s plan, the federal government supplies vaccines to states but leaves it to state officials to prioritize residents, send doses to providers and get shots into people’s arms.

The approach — as well as a litany of logistical problems — has caused a varied distribution effort. Local health departments and hospitals tasked with administering the vaccines have complained that they do not know when shipments will come or if they will receive additional resources, said Oscar Alleyne, and epidemiologist and chief of programs and services for the National Association of County and City Health Officials, which is made up of about 3,000 local health departments.

“Some health departments have only received vaccines as recently as this week,” Alleyne told The Washington Post. “I had one health department that told me they had received their vaccines the day after Christmas.”

Alleyne compared the communication concerns to those that cropped up during the H1N1 pandemic in 2009, when unclear guidance hampered efforts to get the population vaccinated.

“It really boils down to ensuring a very transparent process,” Alleyne said.

“There will always be a lag between the doses allocated and those shipped; between those shipped and those administered; and between those administered and those reported to CDC as administered,” Michael J. Pratt, a spokesperson for Operation Warp Speed, said in a statement. “We’re working to make those lags as small as possible.”

At the Texas Medical Center, the largest medical complex in the world, the approach has already created logistical challenges. Hospital officials on the campus in south Houston often don’t know exactly when to expect new shipments or precisely how many vials they’ll receive, according to Bill McKeon, the center’s chief executive officer. That leaves the center with just a couple days’ worth of vaccine inventory on hand at a time, he said.

“At best, we hear estimates. It’s a day-to-day situation,” McKeon told The Post. “We hear that we may be getting more next week but we’re not sure.”

To date, the center has administered the first of the two injections to about 60,000 people, averaging more than 4,000 a day, according to McKeon. That includes some of the center’s 120,000 employees, as well as patients with underlying conditions who are first in line for inoculation. But it’s only a tiny portion of the sprawling metropolitan area the center serves.

Until hospital officials can better predict how many vaccine doses they’ll have available week after week, McKeon said, vaccinating more people, faster, will be an uphill battle.

“You can’t do scheduling with a couple days of inventory. We wouldn’t put a patient through the process of coming to the hospital, leaving their home, and then say, ‘Sorry we don’t have the inventory,’ ” he said. “We can’t be bold and just say, ‘Let’s do ten thousand a day.’ ”

McKeon called on the federal government to take a more active role, possibly offering more large-scale vaccination centers, and relieve pressure on state officials, whom he said were “rowing in the same direction” as providers. There will be a growing need not just for more health-care workers to give the shots, he said, but for people who can perform the administrative work of calling patients, verifying their personal information and signing them up for injections.

“I’m not seeing the grand strategies on a national basis, and I’m concerned, because this is a war,” he said. “Every day that we delay on some of those grander strategies we’re going to see losses of life.”

As the distribution of vaccines has proceeded in fits and starts, coronavirus deaths and hospitalizations have soared to new heights. More than 125,000 people around the country were in hospital beds battling covid-19, the disease caused by the virus. Hospitalizations have exceeded 100,000 since Dec. 2.

The nation on Wednesday also recorded a record 3,862 deaths in a day. The previous record, set on Dec. 17, was 3,406.

New daily reported cases were trending upward again, after dipping during the week of Christmas. Family gatherings and spikes in holiday travel make it all but certain that the new year will bring yet another wave of infections.

Compounding fears about the accelerating virus spread, a new, more transmissible variant of the coronavirus has cropped up in multiple U.S. states after circulating in the United Kingdom.

The presence of the mutated pathogen only added to the need for vaccinations to ramp up quickly, said Scott Gottlieb, former Food and Drug Administration commissioner.

“The Covid vaccine could be a tool to help reduce the impact of current wave of epidemic spread,” he tweeted Thursday. “But we’re largely missing the narrow window we had to deploy it rapidly enough to alter the present trajectory of death and disease in January. The new variant makes this more urgent.”

Clarification: This story has been updated to cite Operation Warp Speed’s distribution numbers. It has also been updated to note that Operation Warp Speed has allocated 20 million vaccine doses to states.