The federal government has invested more than $18 billion in the rapid development and nationwide distribution of COVID-19 vaccines. Now that the first vaccine has been authorized for emergency use and is making its way to frontline providers, state and local public health agencies will be largely responsible for reaching the “last mile” of immunization — broad vaccination of the American public.

On To the Point, Commonwealth Fund President David Blumenthal, M.D., Mark McClellan, M.D., and colleagues describe the formidable challenges that state health officials face. Lack of funding presents a major obstacle, they say. It’s estimated that an additional $8.4 billion in federal funds are needed to support an effective and equitable vaccine rollout, but so far only $200 million has been allocated to states for what will be the largest and most complex vaccination effort in our nation’s history.

The U.S. stands poised to reverse the pandemic. But “[f]ailing to provide the funds that state and local governments need now to get COVID-19 vaccines into the arms of millions of Americans across the country puts vaccination success at risk — which would be a true national tragedy.”