President-elect Joe Biden outlined plans for a $20 billion national vaccination program as part of a broader legislative package that would steer hundreds of billions of dollars toward state and municipal efforts to respond to the Covid-19 outbreak.

The program would work with states and other authorities to open vaccination clinics nationwide and send mobile units to out-of-the-way communities, according to a fact sheet provided by the Biden transition team.

The vaccination plan is part of a broader $1.9 trillion package that includes $400 billion in Covid response funds to help schools reopen and give workers paid sick leave. Biden also wants to send checks for $1,400 to millions of Americans, on top of the $600 direct payments approved by Congress in December.

How effectively Biden’s administration can ramp up vaccinations will likely shape how quickly the U.S. can get a handle on the raging Covid pandemic, which is setting new records for daily cases, hospitalizations and deaths. Through Thursday, more than 23 million Americans had contracted the virus since the start of the pandemic, and some 387,000 had died from it, according to Johns Hopkins University data.

Biden has pledged to deliver 100 million vaccine doses in his first 100 days. Even at that rate, with the current vaccines requiring two doses, it would take far longer to reach the broad level of immunity needed to curb the virus’s spread. The pace of immunizations will ultimately be constrained by the number of doses drugmakers can produce.

The nationwide vaccination effort has also been complicated by states adopting different approaches to deciding who should have the earliest access to shots and hindered by poor communication about supplies.

The U.S. so far has administered about 10.8 million doses, or 37% of the shots distributed nationwide, according to Bloomberg’s vaccine tracker. With expanded eligibility announced this week, another 128 million Americans can potentially get shots.

The outline offered few details of how Biden’s administration plans to scale up vaccinations. In addition to new immunization sites and mobile clinics, it calls for boosting funding to states to administer the vaccine to patients on Medicaid, the safety-net insurance program for the poor. The plan also notes that the vaccine should be free to all people in the U.S., regardless of immigration status.

Additionally, Biden proposed increasing surveillance for new variants of the coronavirus, calling the lack of capacity to detect new mutations a “key vulnerability” in the U.S. Covid response.

Biden is also calling Congress to boost funding for other aspects of the pandemic response, including:

• $50 billion for expanded testing, including in schools and local governments
• Hiring 100,000 public-health workers for contact tracing and vaccine outreach
• $30 billion to address supply shortages and $10 billion for domestic manufacturing of medical supplies
• $130 billion to help schools re-open safely.

By John Tozzi