The Trump administration is set to announce Tuesday it will encourage states to begin vaccinating people who are 65 or older and people with certain pre-existing conditions in an effort to accelerate the nation’s sluggish COVID-19 vaccine rollout.

The administration also announced it plans to send the vaccine to more places, including community pharmacies and smaller health practices. It plans to free up as many doses as it has available in order to boost supply, a major roadblock to sending the vaccine to more sites.

The administration’s previous policy was to hold back half of its supply to ensure people who received one shot would be able to get access to their second, but officials now argue manufacturing is reliable enough that people getting a first dose now should be able to get a second dose later.

The policy shifts are a concession by the administration that it fell far short of its goal to vaccinate 20 million people by the end of last year, in part due to planning lapses. That target was already revised down from a promise made last summer to vaccinate 100 million people by the end of the year, and again scaled back last fall from 40 million people by the end of the year.

So far, about 25 million vaccines have been distributed, while 9 million shots have been administered, according to Centers for Disease Control and Prevention data.

Millions more Americans would become eligible to get vaccinated in the near future under the new recommendations.

While the new policies are expected to address some key problems, they may pose their own challenges.

Increasing vaccination sites

By freeing up more doses of the vaccine, the administration hopes to send it to more sites and make it easier for people to access.

In the fall, the Trump administration said it would ship the vaccine to 65,000 to 75,000 places. But as vaccinations started, federal officials announced they would ship the first doses of the vaccine by Pfizer and BioNTech to 636 vaccination sites across the country and a separate authorized vaccine by Moderna to 3,285 U.S. locations.

The administration announced Tuesday that the number of administration sites has increased to 16,000 sites since it began releasing more vaccines to pharmacies last week.

So while major hospitals and health care systems have vaccinated administrators and other staff with little exposure to the virus, frontline health care workers at high risk in smaller doctors’ offices have struggled to get the vaccine.

Health and Human Services Secretary Alex Azar blamed the slow rollout on state health departments.

“The administration in the states has been too narrowly focused,” Azar said in a television interview Tuesday morning. “The process has been overly hospitalized so far in too many states.”

State health departments counter that they struggled to recruit more medical providers to administer the vaccine with just a few million dollars from the federal government to prepare. While Azar said doctors could look forward to funding from an “administration fee” for giving the vaccine, there was little federal funding to get up and running.

Meanwhile, hospitals argue that while they were designated by states as vaccination hubs, they weren’t given instruction on how they should share doses with other health care providers or multi-task with vaccinations while caring for a surge of infected patients. The Trump administration is not having regular calls with hospitals, according to the American Hospital Association, the country’s largest hospital lobbying group.

Hospitals also say it’s difficult to plan to distribute a vaccine to new places given inconsistent shipments.

Azar, meanwhile, said there are vaccines in warehouses that states haven’t yet ordered.

Millions more eligible

The administration is recommending that people 65 years old or older and people with certain co-morbid conditions that make COVID-19 more deadly get access before health care workers and nursing homes have been fully immunized.

That’s a departure from the CDC’s priority guidelines, which suggest frontline essential workers at high risk of exposure get the vaccine next.

Under the new plan, the medical conditions at issue include cancer; chronic kidney disease; chronic obstructive pulmonary disease; heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies; immunocompromised state from solid organ transplant; obesity; sickle cell disease; smoking; type 2 diabetes mellitus; and pregnancy.

Given the Trump administration’s states-first approach, final decisions about priority will fall to governors. Some states have already elected to begin vaccinating some essential workers like teachers and law enforcement officers.

Loosening the priority guidelines will likely pose logistical challenges to states and hospitals already burdened with a COVID-19 surge.

For example, health officials in Alabama opened up eligibility Friday afternoon and hospital switchboards became overwhelmed with calls, which could undermine communications and patient care.

While the administration wants to open up priority groups early, the change is not a huge deviation from the timeline the administration projected before it hit major roadblocks. CDC previously projected immunizing health care workers would be completed within three weeks in December.