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US Government funds to distribute updated Covid vaccines has dried up.

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At the very moment a better coronavirus vaccine is expected to finally become available, America’s vaccination program is feeling the effects of a long period of retreat.

Local programs to bring shots to the places where Americans gather and the institutions they trust have folded, a consequence in some cases of congressional resistance to more pandemic response spending.

The same local health department workers responsible for Covid and flu shots this fall have also, without new staffing, been juggling a monkeypox outbreak and childhood immunization deficits that have left some places susceptible to polio.

And some state health officials, citing weak demand for vaccines and increased survival rates of late, said in interviews that they had stopped aggressively pushing coronavirus shots.

With the virus killing far fewer people than it once did and many Americans reverting to their prepandemic ways, the country’s no-expenses-spared attitude to saving lives has evolved into a response that has put a greater onus on individuals to protect themselves. In keeping with that approach, many health officials believe the vaccine machinery is in place to meet what they expect, lamentably, to be tepid demand this fall.

But others are worried that the country is surrendering a decisive opportunity to stoke that demand and restore the more robust vaccination efforts that lifted last year’s initial rollout.

“We are watching the dismantling of the hyperlocal infrastructure that actually brought needles to arms in the most vulnerable communities in the country,” said Stephen Thomas, the director of the Center for Health Equity at the University of Maryland. “To this day, vaccine uptake in the United States is embarrassing.”

The Biden administration said some 70,000 sites were prepared to vaccinate people this fall. While 60 percent of those are pharmacies, they also include doctor’s offices, community health centers and rural health clinics.

States can also seek money from the Federal Emergency Management Agency for certain vaccination-related expenses, like setting up sites, buying equipment and offering translation or transportation services.

Having shifted much of the rollout to private sites, though, states have been promised FEMA reimbursements on a relatively modest $550 million in vaccination spending so far this year. Last year, that figure was $8.5 billion.

And while providers are supposed to vaccinate everyone for free, with or without insurance, the federal government ran out of money this spring to offer reimbursements for shots for uninsured people, making it more difficult for them to receive boosters.

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