After months of mounting case counts and strained hospital capacity, the past two weeks have brought us some overdue good news in our struggle with the coronavirus pandemic. Both Pfizer / BioNTech and Moderna have announced unexpectedly promising results for their COVID-19 vaccine, which — if they get the FDA’s signoff — could be ready for public use next year. For the first time since the pandemic began, it feels like we have a clear path to returning to everyday life. 

If they are authorized, getting those vaccines out to the general US public will require a huge federal effort, one that is already getting caught in the chaos of the outgoing Trump administration. Two weeks after Election Day, President Trump has yet to acknowledge that he lost the election — and the consequences of that pettiness have effectively frozen the work that would normally be done by the incoming Biden administration. As local agencies start to prepare for the challenge of vaccine distribution, they’re running up against the gridlock caused by Trump’s delayed transition — and officials are starting to give grave warnings about what a delay in vaccine planning might mean.

“We do not have access to official government data, internal data sets,” transition official David Kessler told reporters on a call on Tuesday. “There are career officials at HHS that are right now developing plans for February and March on vaccine distribution ... Our team cannot communicate with them.” 

Speaking to NBC News, president-elect Joe Biden put it in even starker terms. “More people may die if we don’t coordinate,” Biden told NBC’s Geoff Bennett.

The call for a smoother transition has also come from public health officials outside the Biden camp. In an interview with CNN earlier this week, NIAID director Anthony Fauci said the delay would likely degrade the incoming administration’s ability to respond to the coronavirus. “Of course it would be better if we could start working with them,” said Fauci, who has served in six administrations. “You don’t want to stop and then give it to somebody. You want to just essentially keep going, and that’s what transition is. So it certainly would make things [go] more smoothly if we could do that.”

Official results clearly point to a Biden victory, even though a number of late-arriving votes have yet to be officially counted. But in the face of Trump’s refusal to concede, the General Services Administration has refused to give the transition teams access to federal documents or buildings, essentially putting the transition on hold indefinitely. (GSA did not respond to a request for comment.)

That hold extends to the Department of Health and Human Services, which has handled much of the federal coronavirus response. Speaking to Good Morning America earlier this week, HHS secretary Alex Azar said the incoming team couldn’t be brought in on vaccine distribution plans until “GSA determines that there is — if there is — a transition to do.” (Reached for comment, HHS referred queries to GSA.) But with the massive task of nationwide vaccine distribution approaching, the delay is costing public health officials precious time.

The CDC released its official vaccine distribution playbook in August, but there are still lingering questions about how big a role the federal government will play in distributing the vaccine. Most everyday vaccine distribution is performed by state and local health departments, but the extreme nature of the pandemic has driven many experts to call for a coordinated federal response, including Fauci himself.

Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security, says the Trump administration has sent mixed messages on the question, which makes a smooth transition even more important.

“At times, HHS and Operation Warp Speed have said they are providing guidance to the states and the states will do distribution,” Toner says. “At other times, they talk about directly shipping products to hospitals and to nursing homes, bypassing the state health departments. So it’s a little bit confusing.”

In September, the White House laid out a role for the Department of Defense to use military equipment to ship vaccine supplies directly to health centers, but it’s unclear whether that plan has moved forward. The incoming Biden task force might want to modify the plan or shift authority back to the states — but they can’t do any of it until they sit down with the HHS officials who have been making the plans until now. On the other side, local officials won’t know if they’ll be getting military help until they can talk to the incoming HHS team, which can’t happen until the transition officially goes through.

So far, the Biden transition team is keeping quiet about the issue, at least officially. The team did not respond to inquiries about the transition, and specific members of the HHS transition team declined to comment. Still, the Biden team is moving fast, making the first round of staff appointments on Tuesday and pointing to coronavirus response as a chief priority.

The biggest threat to Biden’s coronavirus efforts could be a broader loss of the federal government’s credibility to distribute a vaccine at all. Polls from the summer showed that people are already reluctant to take a COVID-19 vaccine. If the FDA takes the unprecedented step of authorizing a vaccine for emergency use, it’s likely to face even more skepticism from a public already extremely wary of political jockeying over a vaccine. Continued delays to the transition could make regaining the public’s trust even more difficult. 

“As Trump and Republicans who are supporting his messaging continue to undermine the election results, they are also undermining the credibility of the incoming administration,” says Toner. “That is a terrible thing to do from the perspective of public health, and from the perspective of the vaccination program. It puts a lot of people’s health and lives at stake.”