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However, callers to the hospital's COVID-19 line who could get through Monday were allowed to book vaccination appointments for people 65 and older until midday. Then a recording declared appointments for the vaccine were no longer being taken. A call to the hospital's media relations department Monday was not returned. 

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More:Operation Warp Speed is living up to its name, but COVID-19 immunizations are going 'slower' than expected, officials say

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Mount Sinai Medical Center in Miami began offering vaccine to seniors last week, though getting through to the appointment desk proved difficult for many. Monday, multiple attempts by USA TODAY resulted in busy signals. When the line was answered, staff said vaccine was available only to medical center patients.

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That isn't the case, CEO Steven Sonenreich clarified. The medical center offers vaccine to anyone 75 and older and will drop the age limit to 65 when demand eases. The initial rollout has been "a work in progress," he acknowledged.

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"What occurred has been that the vaccine was not here one day, and then all of the sudden, it was here," Sonenreich said, adding that the system vaccinated its physicians and as many other medical workers as wanted it, then opened to others. 

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The hospital hired additional staff members to answer phones and deal with the increase in activity. Though Mount Sinai has always offered immunizations, "no one has a vaccine department," Sonenreich said. 

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In counties where public health departments took the lead in distributing vaccine to the public, the process has been bumpy at best. 

In Seminole County, the Health Department began administering shots to people 65 and older at a mall Monday. An immunization appointment system crashed repeatedly throughout the day, then immediately filled up through Jan. 9. The county asked for patience as it worked through the issues.

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The county level is where such efforts need to be organized, said Dr. Walter Orenstein, associate director of the Emory University Vaccine Center and former director of the U.S. Immunization Program. "It's the states and counties that know where to send the vaccine and what systems to have in place," he said.  

Nowak, the former CDC immunization official, said they need money and time. "This is one of the reasons you've seen so many of the state and county health departments say how important it is that they get additional resources," he said. "The complexity is going to do nothing but increase."

The coronavirus relief and spending package President Donald Trump signed Sunday includes more than $8 billion for states for vaccine distribution. The money should have come much earlier, and with federal support for the effort, Dr. Ashish Jha, dean of the Brown University School of Public Health, tweeted in frustration late Monday. 

"There appears to be no investment or plan in the last mile," Jha wrote. "No effort from Feds to help states launch a real vaccination infrastructure. Did the Feds not know vaccines were coming? Shouldn't planning around vaccination sites, etc not have happened in October or November?"

Orlando's Orange County announced Monday it would begin vaccinating seniors Tuesday at the county convention center. At a news conference earlier in the day, county health officer Dr. Raul Pino warned the process wouldn't go smoothly. 

"Should you expect mistakes? Yes! We're going to have issues," he said. "We'll work on those issues as they come."

They came almost immediately. A website to take appointments went up Monday afternoon but quickly faltered as county residents spent hours refreshing their screens to try to get it to work.

Wayne Frongello, 69, a retired teacher, spent a fruitless hour trying to make an appointment for himself and his 95-year-old father. 

"This rollout has been out of control in terms of any kind of consistency," Frongello said.

He said it was "horrible" that people his age were allowed to be vaccinated before doctors and nurses but decided the immunizations available at the convention centers wouldn't go to health care workers anyway. 

Nor did they go to Frongello and his dad Tuesday after the website crashed on him multiple times.

"Every time I get partway through the process, I could see the number of open appointments dwindling," the Orlando resident said Monday just before midnight. "And now when I try to register, all the slots are filled. I never got to the final booking page at all."