Since the first coronavirus vaccine was approved in the United States three weeks ago, almost 400,000 doses have shipped to North Carolina but little more than a quarter of those have been given out so far.

As of Monday, 101,351 people have gotten their first dose of a coronavirus vaccine in North Carolina, according to data from the Centers for Disease Control and Prevention.

North Carolina’s vaccination rate so far is 966 per 100,000 people, lagging behind most other states in the country. That number for most states is between 1,000 and 2,000.

Of North Carolina’s neighboring states, Tennessee has the highest rate with more than 2,200 per 100,000 people, double North Carolina’s vaccination rate.

Based on the CDC’s vaccination rate data, only five states have a lower rate than North Carolina; Georgia, Alabama, Mississippi, Kansas and Arizona.

"Most sites received vaccine 2 weeks ago and they are ramping up their operations as they handle staffing challenges during the holidays and their other work related to the COVID surge," the state Department of Health and Human Services said in a statement to Spectrum News 1.

"To increase the pace of vaccinations, DHHS sent a letter to all hospitals and local health departments alerting them that future vaccine allocations will be modified based on the number of vaccines administered that they have reported to the state," the department said.

"DHHS is also working on enrolling more providers. Finally, there are anecdotal reports of people who have declined to receive the vaccine when their turn comes up," DHHS says.  

Nationally, more than 15.4 million doses of the vaccines have been distributed and about 4.5 million people have gotten their first shot, according to the CDC. The data can take up to 72 hours to be updated, so the numbers are likely higher, the CDC said.

“We worked with the states to immunize. We agree that there is a lag. We’ll work with the states,” Moncef Slaoui, chief adviser for Operation Warp Speed, said Monday on CNN. “We worked day and night to have these vaccines available and we will continue to work day and night to have them immunized."

The coronavirus vaccine push is the biggest vaccination campaign in United States history. The effort is complicated by the ultra-cold storage needed for the Pfizer vaccine and having to make sure people follow social distancing during the mass-vaccination effort.

North Carolina is still in the first phase of distributing the vaccine, focused on health care workers dealing directly with COVID-19 patients and staff and residents in long-term care facilities.

Counties are starting to move to what’s called “Phase 1b” this week, vaccinating people over 75 and frontline essential workers like police officers, teachers, and grocery store workers. On Monday, Mecklenburg County said people over 75 could make appointments to get a vaccine starting Wednesday.

DeAnne Brooks, the chief pharmacy officer for Cone Health in Greensboro, said her hospital system has received about 10,000 doses of vaccine and given the first shot to more than 4,000 people in the first phase of the vaccine rollout.

“Most vaccines, we can take the vaccine to the people. This is a vaccine that we need to bring the people to the vaccine,” Brooks says. “It’s a little bit slower than we would typically do with our flu vaccine.”

“We don’t want to have long lines of people wrapped around the vaccine to administer the vaccine,” she says. The other challenge in getting the vaccine out faster is that people have to be observed for 15 minutes after they get the shot.

Brooks said Cone Health has had to get more staff on to help administer the vaccines. “It is work that, actually, I’ll say is joyful,” she says, with people celebrating as they get their vaccines.

Both vaccines approved in the United States require two shots. The first people to get the Pfizer vaccine three weeks ago started getting their second doses Monday.

In a call with reporters Monday, Dr. Katie Passaretti, medical director of infection prevention at Atrium Health, said it could take a week or two after the second dose for the vaccines to be 95% effective.

Passaretti, a Charlotte doctor, was the first person to get a coronavirus vaccine in North Carolina.

“It’s been wonderful over the past couple weeks watching more and more people getting vaccinated,” she says. “It gives me hope for the coming weeks, months as far as getting the vaccine out to more and more people and getting protection for our community.”

Public health officials say more vaccine doses are being shipped to North Carolina each week, but it could be spring before they are available for everyone who wants one.

Last week North Carolina updated its vaccination plan and gave a more specific breakdown of who would get priority as they roll out the vaccine.

North Carolina is still in Phase 1a of the plan but could move to Phase 1b this week or next.

Here’s the plan from DHHS:

Phase 1a: Health care workers fighting COVID-19 and longterm care staff and residents.

Hospitals and local health departments are vaccinating health care workers caring for and working directly with patients with COVID-19 and those giving vaccines. In addition, the federal government is vaccinating longterm care residents and staff.

Phase 1b: Adults 75 years or older and frontline essential workers.

This phase of vaccinations will open in groups, which officials say should begin in early January.

• Group 1: Anyone 75 years or older regardless of medical condition or living situation. People do not have to have a chronic health condition.
• Group 2: Health care and frontline essential workers who are 50 years of age or older.
• Group 3: Frontline workers of any age and health care workers of any age, regardless of whether they work directly with COVID-19 patients.

The CDC defines frontline essential workers as first responders (firefighters, police), education (child care, teachers, support staff), manufacturing, corrections officers, public transit, grocery store, food and agriculture, and US postal workers.

Phase 2: Adults at high risk for exposure and at increased risk of severe illness.

In this phase, vaccinations will also open in groups.

• Group 1: Anyone ages 65-74 years regardless of medical condition or living situation.
• Group 2: Anyone 16-64 years with a medical condition that increases risk of severe disease from COVID-19.
• Group 3: Anyone who is incarcerated or living in other close group living settings who has not already vaccinated due to age, medical condition or job function.
• Group 4: Essential workers as defined by the CDC who have not yet been vaccinated.

Phase 3: Students. College, university and high school students 16 or older.

Younger children will only be vaccinated when the vaccine is approved for them.

Phase 4: Finally, anyone who wants a COVID-19 vaccine will be able to get one.