Over the weekend, thousands of people filed through the Charlotte Motor Speedway in North Carolina — now serving as a mass vaccine site — run by Honeywell and other local businesses that have partnered with the state.

Related: The employer's role in creating a COVID-19 testing and vaccination infrastructure

And on Monday, Google pledged $150 million to "promote vaccine education and equitable distribution" and to make it easier for people to find "when and where to get the vaccine."

This backup from businesses comes as states continue to navigate uncertainty around when they'll receive doses. A patchwork of vaccination eligibility rules and ways to sign up for a shot have left many Americans confused, frustrated and even frightened, as those at high risk of serious complications from the covid virus continue to wait with little news on when they'll be inoculated.

Washington Gov. Jay Inslee calls private enterprise the "arsenal" of the coronavirus vaccination campaign, comparing the partnership to the production of battleships during World War II, but even Inslee, a Democrat, did not oversell the immediate impact.

"This is not going to be an expectation of an Amazon delivery system," Inslee said while announcing his state's plan last week. "There will be times when people will not have dosages available in their community because there isn't enough being delivered."

Washington and more than half of all states have opened up vaccines to anyone 65 and older — greatly spiking demand — yet a major hang-up continues to be making use of all the delivered vaccines.

Of the approximately 41 million vaccines delivered to states, more than 19 million have not yet been given, according to data from the Centers for Disease Control and Prevention.

"It's a dance that requires a lot of complex choreography," said Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania.

"We aren't always so innovative and nimble in public health and this is the moment where we need that — we need innovation and we need states trying different things."

The Washington state partnership is using Starbucks to streamline the vaccine clinics, Microsoft to provide tech support and space on its campus, and Costco to manage logistics around delivering the shots.

Every state should be looking to its businesses to fill gaps in the vaccination operations, whether around online scheduling, public messaging or the nitty-gritty details of coordinating delivery and clinics, Buttenheim said.

"There's no one corporate entity that's going to solve this, but most have something to offer," she said.

Many public health departments have struggled with making the vaccine process "customer friendly" because they don't typically provide this kind of direct service, said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials (ASTHO), which represents state health directors.

"It has been challenging to scale those kinds of things up," he said. "Then you add in that public health departments have been dealing with covid for a year, with limited resources and people are tired."

In North Carolina, Atrium Health, a nonprofit health care system, is part of the business partnership with Honeywell that aims to give 1 million shots by July.

"It allows us as the health care system to focus on what we do best — getting the shots in the arms and making sure people are tolerating it and the aftercare," said Dr. Scott Rissmiller, Atrium's executive vice president.

"Our hospitals are full, and it's the same people that are working in our hospitals that we are needing to redeploy for the vaccines."

Looking ahead 

The Biden administration has pledged more transparency around the availability of doses and enlisted the Federal Emergency Management Agency to set up mass vaccination sites, as many as 100 in the next month.

While the pace of vaccination has picked up, public health experts warn the U.S. must move faster as at least one more contagious variant of the virus shows up in a growing number of states and threatens to drive another devastating surge.

A federal partnership with large pharmacies has faced criticism for not moving more quickly. Some states have gone through the majority of their doses, while others have used fewer than half of what's been delivered.

Public health can get a boost from the private sector, but there are limits to what can be outsourced, said epidemiologist Jennifer Nuzzo of Johns Hopkins University.

"This isn't just handing somebody a package; this is a clinical encounter," said Nuzzo.

Data entry involves sensitive personal information, and the actual vaccinators need to be trained and credentialed.

Nuzzo, who has studied the U.S. capacity for mass vaccination, estimates the U.S. will need anywhere from 100,000 to 184,000 people to staff vaccine clinics, of which 17,000 would have to be vaccinators, to meet the Biden administration's goal of 100 million shots in 100 days.

"I think it would be extraordinarily difficult to just find those vaccinators," she said.

The private sector may be able to contribute, but Nuzzo cautioned that any partnerships cannot appear to favor the employees of the company.

Last week, Amazon offered to assist the Biden administration on the vaccine rollout and has signaled it hopes to vaccinate its own front-line workers as soon as possible.

The shaky supply has limited the ability of some states to pursue mass vaccine sites, and many providers are still hesitant to schedule vaccines too far in advance. A hospital in Arlington, Virginia, canceled 10,000 appointments after the state changed how it allocates its supply of vaccines.

In Arizona, which has two mass vaccine sites so far, appointments are already booked through February.

Since the early days of the vaccine rollout — when the Trump administration promised 20 million doses before 2021 — the public has received confusing messages about when they'll be able to get a shot.

States still face the challenge of how to set realistic expectations. Many are ramping up their capacity for giving vaccines, even before the supply has caught up.

"The worry I have is that if we create expectations for how quickly people can get vaccinated and then don't deliver, people will become perhaps jaded or disappointed or, worse, mistrustful of vaccination efforts," she said.

More than half of unvaccinated Americans say they need more information about when or where they'll get vaccinated, according to a national survey from the Kaiser Family Foundation. (KHN is an editorially independent program of KFF.)

At his grocery store in Everett, Wash., Wil Peterson, a cashier, hears this confusion around the vaccine process from his co-workers.

"There's a lot of information that's been floating around, so I'm just trying to keep up with the latest developments," said Peterson, who's in his 50s and expects his turn to get a shot will come sometime in February.

Peterson worries about catching the virus every day he goes to work and still deals with customers who refuse to wear masks, so he's eager to get vaccinated.

But he also knows it may not go smoothly, after hearing from a friend who tried to sign up for his shot.

"But the site crashed, so I'm kind of bracing for maybe that happening when I try to do it, but I'm hoping that won't be the case," he said.

This story is part of a partnership that includes NPR and KHN. It can be republished for free. KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.

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