President Joe Biden’s new goal of expanding vaccine eligibility to all adults by May 1 could quickly slam into states’ complex appointment systems, lingering supply questions and challenges ensuring shots make it quickly to vulnerable populations.

In Oklahoma, state officials say they’re still rushing to add sites for administering the vaccines. In West Virginia, officials worry that extending vaccine sign-ups to everyone threatens to leave behind those at highest risk from the virus. In Oregon, state officials are weighing whether they’ll need federal help to scale up their new online appointment system in time.

Renewed concerns from state officials a day after Biden’s prime time address, where he set the target for busting open vaccine eligibility, reinforce that it may still be months before all Americans eager to get their shots can actually roll up their sleeves. And despite optimism from Biden about the ever-accelerating pace of vaccinations, logistical on-the-ground challenges — including some well out of his administration’s control — could still trip up his goal for Americans to regain a sense of normalcy by this summer.

State officials on Friday sounded hopeful they could meet the new May 1 target, which Biden announced after giving governors just a couple hours’ notice Thursday night. But they’re also cautious of overpromising, acknowledging that any number of factors could trip up the vaccination effort. It’s a harsh truth that public officials will have to message carefully to avoid further frustrating a crisis-weary public eager to put the pandemic behind them.

“It’s a good thing to aspire to, but I just think we need to probably keep an eye and see how we’re doing when we get into April,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials, said of Biden’s goal.

Anticipating an influx of doses, some states had already expected to open up once-scarce shots to all adults in the coming weeks. After Alaska became the first to do so Tuesday, governors in Utah and Michigan announced moves toward that direction this week. Ohio and Connecticut are also on track for meeting Biden’s goal, spokespersons for those governors said.

White House officials have repeatedly pitched themselves as willing partners to help states vaccinate their residents, a contrast with the Trump administration, which left states to handle much of the lift. Biden is promising new federal resources to aid the effort, fresh off signing a $1.9 trillion Covid relief plan passed just with Democratic votes. That includes significantly expanding the number of mass vaccination sites, pharmacies and community health centers providing the shots and dispatching more medical personnel across the country. The administration is also promising to set up a new nationwide website and call center by May 1 to help Americans arrange appointments, while promising new tech help for states to improve their own sign-up systems.

“We spent a lot of time working through supply, the number of places, the number of vaccinators, and we believe May 1 is the right deadline,” White House coronavirus coordinator Jeff Zients said during a Friday press briefing.

Despite the new federal help, state officials are still working through logistical issues that may not be fully resolved in the next seven weeks.

In Oklahoma, where the state has already opened up eligibility to the vast majority of adults, officials say they’re trying to set up more vaccination sites across the state to accommodate increased supply.

“It doesn’t do us a lot of good to have millions of doses or hundreds of thousands of doses and only have a narrow venue by which somebody can access it,” said Oklahoma health deputy commissioner Keith Reed.

Some state officials also said they worried about moving too quickly to expand eligibility when many high-risk people still haven’t had a chance to make appointments. Many states that sought to prioritize eligibility based on risk have already thrown out those playbooks as the vaccination effort lagged.

“We also start to be able to lose that control over that hierarchy of vulnerable patients, so we want to make sure that we’re really focused on [that]," said Clay Marsh, West Virginia state’s coronavirus czar. His state could open eligibility broadly within the next month, he said.

Since the sluggish start of the nation’s vaccination campaign, the pace has quickened to over 2 million doses per day. The U.S. on Friday crossed the milestone of 100 million doses administered since the vaccination campaign began almost three months ago. A quarter of the adult population has received at least their first shot, including 61 percent of people age 65 and older, a group especially susceptible to the virus.

An expected surge in vaccine production in the coming weeks should mean that states are flooded with new doses. But some state officials say they’re reluctant to plan too far ahead without having a concrete sense of their expected allotments. The Biden administration has been giving states at least three weeks’ notice of anticipated shipments, but it has promised to provide a larger window to help with their planning.

In Oregon, state officials originally planned to open up vaccine eligibility to anyone over age 45 on June 1 and to the general population by July 1. But the state will speed up that timeline “if the doses increase," a top official said.

“We’ll know a lot more when we have better visibility of our vaccine supply,” said Patrick Allen, the head of the Oregon Health Authority.

The state is considering taking up the Biden administration’s offer of technical assistance to scale up its registration system, Allen said. The state recently overhauled its glitchy appointment system after Portland-area residents made 400,000 attempts to schedule just 3,400 appointments at the Oregon Convention Center. It’s now requiring residents to pre-register, with the state picking names through a lottery — a system that Allen says is “scalable.”

Other health officials said the May 1 target would help states set priorities.

“It’s good to know that that’s the vision — that that is something that’s being put out there in advance, so that we can make sure that our systems and strategies are up to the task by May 1,” said Adriane Casalotti, head of government affairs for the National Association of County and City Health Officials.

“There’s a lot that needs to be done in our systems and collaboration across public health and health care to be ready for that date,” Casalotti added.

Brianna Ehley contributed to this report.

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