It is a question that as many as 5 million New Yorkers would like to hear answered.
When will Gov. Andrew M. Cuomo act on President Biden's directive to open Covid-19 vaccinations to all adults?
In a TV speech Thursday, Biden said he would order all states to make the vaccine available to everyone over 18 by May 1.
A few governors have acted already. Tuesday, Ohio's Mike DeWine declared eligibility to everyone over 16 in his state as of March 29. That came a day after Mississippi's Tate Reeves declared immediate eligibility for all adults. Alaska made the move last week, Michigan announced it would do so as of April 5, and Arizona lowered its eligible age to 45 with plans to meet Biden's May 1 goal.
But so far, nothing from Cuomo.
He said the day after Biden's speech that implementing the president's policy will be "a logistical undertaking unlike anything we have done before."
More than half of New York's population – by virtue of their jobs, their medical history or being 60 or older – already is eligible to obtain a shot if they can find an appointment. But Biden's demand would increase New York's eligibles from 10 million to 15 million, according to the governor.
"Once you tell people they are eligible, then eligibility suggests, 'Now I should be able to get it,' and we're going to have to dramatically increase our capacity to do that, because we are not at that capacity now," Cuomo said Friday.
Dr. Thomas Russo, chief of infectious diseases at the University at Buffalo's Jacobs School of Medicine and Biomedical Sciences, noted that New York has been "pretty liberal" in its approach to creating a priority list. But he warned that the state should not move too quickly.
"It’s good in that we want to get the vaccine to vulnerable people as soon as possible, but when there are supply limitations, that generates frustration where you’re not able to get the vaccine, get the appointments, so it’s sort of a two-edged sword," Russo said.
Biden also promised that there would be 800 million doses available, which is far more vaccine that would be needed to vaccinate every American twice. The government actually had placed those doses under contract for delivery by July 31 before Biden took office.
Wielding the needles
Biden said that he will deploy active-duty military members to help with vaccinations, and the Department of Health and Human Services will set up a national website to gather volunteers to wield the needles where necessary.
“We’ve called out for certain students and health sciences to be part of that process, so I’m hoping that we’ll have enough individuals to get it done," Russo said.
“It’s relatively facile to train certain people in health professions to go ahead and vaccinate, such as medical students, pharmacy students, etc. We have a moderate amount of pharmacy students here, physicians’ assistants that are in training, so I’m hoping we can get it done," Russo added.
The Biden administration has enlarged the pool of people allowed to give shots to include emergency medical technicians and paramedics, dentists, optometrists, midwives, podiatrists and veterinarians.
More vaccinations available
Despite a lack of any announcement from Cuomo on universal vaccination, it was clear that the state is making plans.
As of Tuesday afternoon, the state Health Department website, which long had not offered any appointments beyond April 16, listed scores of appointments available until May 31 at its long-standing mass vaccination sites in Rochester, Syracuse and points farther east, although not in Buffalo.
The state is planning to open 10 more large-scale vaccination sites, including one at the Conference Center Niagara Falls, which Niagara Falls Mayor Robert M. Restaino said is targeted to open Friday.
It opened other sites, including the Delavan-Grider community Center in Buffalo, for vaccinations that at first were restricted to residents of particular ZIP codes before being thrown open to all eligibles. The Delavan-Grider site will vaccinate about 40,000 people by late April.
The state operated three short-term sites, including locations in Olean and Batavia, from March 5-9, each of which administered 3,500 shots of the one-dose Johnson & Johnson vaccine.
The state also has held 149 pop-up clinics all over the state, most open for only a day, but 58,000 people have been vaccinated at those locations, which temporarily reopen when it is time for second shots.
Dr. Nancy Nielsen, senior associate dean of UB's Jacobs School and former president of the American Medical Association, is the leader of a vaccination planning committee for Western New York. But her position doesn't give her any knowledge of when Cuomo will green-light shots for all adults.
“I have not heard anything from the state about that. As you know, we’ve got a big backlog right now of people who are eligible that can’t get an appointment because we just don’t have enough vaccine. And the more people who are eligible, the more demand for those appointments. That's the bad news," Nielsen said.
"The good news, though, is important, and that is that last week we got twice the allocation that we got in our region just four or five weeks ago," she added.
Last week's Western New York allocation was about 39,000 doses. This week, it was cut to 28,000 to 29,000 doses, Nielsen said.
“The weekly supply is up considerably, but it’s not predictable yet," she said. "I believe the state is trying to parcel out as much as they get. In our region, we are extremely efficient in getting those doses dispensed.”
As of Monday, 6.5 million shots had been administered in New York, including 1 million in the previous week.
Can he do that?
Normally, presidents don't order governors to do things.
But because of the way America's vaccination program was set up, Biden's May 1 order is legal, according to Matt Steilen, a professor at the University at Buffalo Law School.
"The federal government had purchased the vaccines and made them available to the states. When they do that, they can condition the receipt of federal funds or federal support – vaccines, in this case – upon a state’s agreement to follow federal guidelines or federal rules," said Steilen, who teaches constitutional law and legal history.
“That’s a typical federal-state partnership based on a federal spending program that makes resources available to the states.” he added. “When a state voluntarily agrees to accept federal resources, then the federal government can specify the conditions under which those resources are to be received.”
It would not be far-fetched to imagine politics entering into the equation for Cuomo, who has been besieged by scandal since several women accused him of sexual misconduct.
“I believe the governor is probably motivated to do whatever he can to make the people of New York happy right now, in terms of vaccination appointments," Russo said.