The federal government has delivered 356,650 doses of vaccine to Washington state, but only a fraction of those doses have been used, according to data from the state health department.

Less than 20% of the distribution — 59,491 doses — had been administered, the state Department of Health said Wednesday morning. The department’s immunization data reporting lags by about three days.

The health department estimates that about 500,000 people qualify for vaccination in the top priority group, named 1A, which includes high-risk workers in health care, first responders and residents of long-term care facilities.

To speed the pace of vaccination in some areas, the health department announced Wednesday that it was expanding the definition of the 1A category to allow extra vaccine to be distributed to health-care workers who are not on the front lines.

“We need to deliver vaccine as quickly as possible, and we have to get it to the right people as quickly as possible,” said Dr. Umair Shah, the state’s new health secretary. The new guidance benefits rural health-care organizations that were able to quickly administer the vaccine to high-risk staffers but still have some doses remaining.

Concern has grown nationally about the pace of vaccination. For all the money the federal government spent on vaccine development and distribution, investments in local and state public-health departments have lagged, leaving underfunded public health agencies and busy, stressed hospitals managing the crucial step of getting shots into people’s arms.

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“We are below where we want to be,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN Tuesday. “I believe as we get into January, we are going to see an increase in momentum.”

Washington state officials agreed that the pace of vaccination should improve over time.

“We don’t have a predictable delivery schedule from the CDC,” said Michele Roberts, the state Department of Health’s acting assistant secretary, speaking of the Centers for Disease Control and Prevention. The majority of last week’s Moderna shipment landed on the holiday weekend, Roberts said, which slowed administration.

“Logistics and timing — those are all things we’ll smooth out after the New Year,” Roberts said, adding that it took a tremendous amount of planning for local agencies and hospitals.

The health department this week expects to receive 57,500 more doses of the Pfizer-BioNtech vaccine and 44,500 doses from Moderna.

Tracking where vaccine administration has lagged is difficult. The health department has repeatedly declined to share with The Seattle Times a list of destinations where vaccine is being delivered, citing security and other concerns.

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Many states have launched vaccination dashboards so the public can track immunization progress. Washington had hoped to publish its own dashboard by the end of this month but shifted that timeline to mid-January because of staffing, according to a health-department spokeswoman.

Other states, including California and Colorado, have laid out plans for their next tiers of vaccination. Washington health officials said they’re working with Gov. Jay Inslee and his staff on finalizing details. Those plans will be shared with the public next week. Vaccinations in this tier could start sometime in January.

“We are in active discussions with him,” Shah said of the governor.

The next waves of vaccination could include some essential workers, seniors and people with significant health risks that intersect with COVID-19.

In a November presentation to a group of state officials, the state health department was considering a second vaccination tier that would include people living in congregate housing where the majority of residents had comorbidities or were 65 and older.

Besides long-term care facilities, the department gave the examples of farmworker housing, prisons and homeless shelters, according to the document, which was obtained by The Seattle Times through a public disclosure request. That consideration predated federal guidance on vaccine prioritization, which the state is now using to make decisions.

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Hospitals and organizations with essential workers were eager to receive any information about the next tier of vaccination.

“It’s challenging to schedule your own employees who you know, and whose phone numbers you have, and whose addresses you have,” said Cassie Sauer, president of the Washington Hospital Association, during a media briefing Monday. “The sooner we know who is in the 1B category, the sooner we can start reaching out to those people.”

Tammie Hetrick, the president and chief executive officer of the Washington Food Industry Association, said grocers have been asking her if their front-line, essential workers would be included in the next wave of vaccinations. She doesn’t have an answer yet.

“We’re really evaluating this and trying to put a plan together,” Hetrick said Tuesday. “This needs to be a thoughtful process, and I’m concerned some of these details haven’t been worked through.”

Erik Nicholson, who is representing the nonprofit United Farm Workers Foundation, said he was not aware of any decisions regarding where Washington’s farmworkers are prioritized.

“We’ve been talking to agriculture employers and growers [about] how we can partner to do this. Everyone is waiting,” said Nicholson, who acknowledged that many industry and advocacy groups were requesting early vaccine access.

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“We want to make sure, in the feeding frenzy that may well ensue with access to the vaccines, that the essential men and women who feed us every day are at the front of the line,” Nicholson said.

Nicholson said vaccine rollout in rural communities could be complicated. Snow and weather can make travel difficult during the winter months. Vaccine sites might be some distance from where workers live. Washington relies on temporary agriculture workers from other countries who will arrive to the state at different times.

“How are we going to get the vaccine to the rural part of the state and into people’s arms?” Nicholson said. “When and how are these decisions being made, so we can get to work?”

Seattle Times reporter Mike Reicher contributed to this story.