It took three months for Massachusetts to fully vaccinate one million residents against the coronavirus. It took less than a month for the state to immunize its second million.
State officials will face their biggest test yet, starting Monday, when about 1.7 million more residents ages 16 through 54 become eligible for shots as the COVID-19 vaccination drive enters its fifth — and most pivotal — month.
“The next two to three weeks are critical to vaccinating everyone we can in the state,” said Rodrigo Martinez, chief experience officer at CIC Health, which has given shots to about 650,000 people so far at the mass vaccination sites it operates in Boston’s Hynes Convention Center and Reggie Lewis Center and at Gillette Stadium in Foxborough.
Vaccine seekers once feared that Patriots’ Day might bring a repeat of Feb. 18, a star-crossed day when a maelstrom of website crashes, system errors, and no-appointment notices dashed the hopes of tens of thousands. Baker administration officials and vaccinators say that, while a new surge of demand is likely, the recently launched pre-registration system and improved logistics at the vaccine sites have left them better prepared to meet it.
In fact, many public health experts are already looking to the other side of the coming surge when the most pressing challenge will become reaching the remote, the ambivalent, and the hesitant.
“We will at some point reach a point where it will turn over and it will be more supply than demand,” said Gabriela Andujar Vazquez, infectious disease doctor at Tufts Medical Center.
Massachusetts as a whole isn’t there yet. But signs of that shift can be seen now in some other states, from New Hampshire to Mississippi, where there are now more vaccine doses available than people who want them — and even in some pockets of Massachusetts where residents of the communities hardest hit by the coronavirus remain skeptical of the vaccine.
“The last 5,000 people in Lynn to be vaccinated are going to be as much work as the first 55,000,” said Kiame Mahaniah, chief executive of the Lynn Community Health Center, where there have been shorter waits for shots in the past week.
Mahaniah saw a 20 percent no-show rate for vaccinations in the Lynn health center last Tuesday, after the state halted use of the Johnson & Johnson vaccine so federal officials could investigate rare blood clots in six recipients.
But demand for the shots remains steady at larger vaccination sites. “We’re filling up every slot every week,” said Dr. Tom Sequist, chief patient experience and equity officer at Mass General Brigham, which has vaccinated more than 150,000 patients and employees. “There are still a lot of residents out there who are anxious and eager to get the vaccine.”
Though the suspension of the single-dose J&J shot was a setback for vaccine programs everywhere, Massachusetts is now administering an average of more than 90,000 shots a day. It has fully vaccinated 2 million adults, putting it nearly halfway to Governor Charlie Baker’s target of immunizing 4.1 million residents by the Fourth of July.
The giant vaccination centers, like other sites run by hospitals, doctors groups, retail pharmacies, community health centers, and regional collaboratives, continue to use the two-dose vaccines from Pfizer-BioNTech and Cambridge-based Moderna. The absence of J&J’s shots, at least through the end of this week, will slow vaccinations elsewhere as people who had been scheduled to get the one-shot J&J vaccine have to be switched to one of the vaccines requiring two shots.
Even so, Baker said at a press briefing at the Hynes last week, the decision to open vaccine bookings to all adults on Monday — a move that is also happening in much of the country — “is a significant milestone in our mission to vaccinate eligible residents and bring this pandemic to a close.”
With the state getting modest increases in its weekly vaccine allocations, and the White House ratcheting up direct shipments to CVS stores and other channels, the potential for frustrating residents eager for shots seems diminished. Still, there are places in Massachusetts where people still struggle to book their appointments.
At the Northampton vaccination clinic she runs, Merridith O’Leary, the city’s public health director, said appointments typically disappear in an hour or less.
“We need the supply,” O’Leary said. “We have the capacity and the resources. We just need the supply.”
The pre-registration system Baker administration officials installed last month has put hundreds of thousands of residents in the queue for shots even before they were eligible.
As of last week, over 1.6 million had pre-registered at mass vaccination sites and a half dozen regional vaccination centers, said Kate Reilly, spokeswoman for the state’s COVID-19 Response Command Center. More than 1 million of those have been contacted to schedule appointments, she said, while about 300,000 others had dropped their registration, often because they found vaccination slots through their own physicians or through local pharmacies.
State officials and injection site operators have already begun targeting outreach efforts to hesitant residents. Vaccinators have been sending doses from the Hynes to “pop-up” vaccination sites in Chelsea, Revere, New Bedford, Fall River, and Boston neighborhoods such as East Boston, Roxbury, and Mattapan.
And, the Baker administration said it was working with the Boston Red Sox and community organizations to sponsor “Red Sox Week” at the Hynes, reserving 20,000 first doses of vaccine at the site this week for communities of color.
To inoculate the people who are most hesitant to get the vaccine, Lynn health center’s Mahaniah said, “you will have to meet them where they are at, both philosophically and logistically.” In Lynn, he said, his health center is preparing to expand pop-up and mobile vaccine clinics, along with a door-to-door campaign.
The challenge Massachusetts will face in the coming weeks as supply begins to exceed demand is already surfacing in other states. New Hampshire is allowing out-of-state residents to be vaccinated there as of Monday, with Governor Chris Sununu citing an abundance of supply.
In Mississippi, tens of thousands of doses sat unwanted this month. And in Texas, vaccines are available at pharmacies in rural areas, even as city CVS locations remain booked.
In the big cities, “it’s a nightmare” to find a vaccine, said Kelly Cheek, a director of the Texas Rural Health Association. “But if you’re willing to drive three or four hours, you can find it.”
At several affiliates of North Country Healthcare, which serves a mostly rural patient population across New Hampshire, which has already expanded its eligibility to all adults, the last two weeks have marked a surprising shift, administrators said.
At first, the problem was inadequate supply: Providers had the capacity to administer five or 10 times as many doses of vaccine as they were receiving, said James Patry the system’s director of patient experience. Patients had to wait to book slots.
Now, as supply increases and hesitancy persists, Patry said, the hospital has a new challenge: “lack of arms to put the vaccine into.”
But on Patriots’ Day in Massachusetts, no one expects a shortage of arms just yet, and Martinez believes the state’s mass vaccination sites can handle the surge in traffic.
“We want to be ready to ride that wave,” he said.
Robert Weisman can be reached at robert.weisman@globe.com. Follow him on Twitter @GlobeRobW. Emma Platoff can be reached at emma.platoff@globe.com. Follow her on Twitter @emmaplatoff.
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