And in cities and states across the country, the blame game, between federal, state and local government, Democrats and Republicans, the old administration and the new — or, predictably, New York City Mayor Bill de Blasio and Cuomo, the state’s governor — has already begun. There will be more.

The stunning development of effective vaccines in under a year has careened into a great big mess of an immunization operation in most U.S. states. The outgoing Trump administration changed policy in its final days, announcing Tuesday that it would push more vaccine out to states and give governors more flexibility to start vaccinating a broader swath of the population, including older Americans — although there aren’t yet enough shots to go around. The federal government helped speed up research and manufacturing, but it had left the hard work of getting vaccines into people’s arms largely to states.

President-elect Joe Biden plans to outline his own vaccination plans Thursday, after faulting President Donald Trump for failing to get the vaccine “from those vials into people’s arms.” Mass vaccination is the only way to end the year-old pandemic that is now claiming as many as 4,000 lives a day in the U.S., swamping hospitals and pounding the economy.

Several states have already begun to do what de Blasio helped prod Cuomo to do: loosening the strict first-wave eligibility rules to get more shots to vulnerable people fast, including people over 65 and some essential workers, such as teachers. New York City is opening five mass vaccination sites, including in some hard-hit minority neighborhoods.

Because 2021 is a political off-year, the biggest effect may not be seen at the polls right away — even if leadership, or lack thereof, may permanently shape how voters perceive officeholders and their challengers in the future.

Only in New Jersey, Virginia and, maybe, California will voters deliver a vaccine verdict this November — a first test of where governors stand ahead of the dozens of midterm elections slated for 2022.

All three have Democratic governors who are wrestling with a flawed vaccine policy set by the Republican Trump administration: New Jersey Gov. Phil Murphy so far remains popular as he seeks reelection. Virginia Gov. Ralph Northam cannot seek another term, but the Democrat’s performance on immunization will likely spill into the race for his successor, strategists in both parties agree. In California, Newsom faces crisis upon crisis as those who seek to oust him claim to have amassed hundreds of thousands of signatures in support of a recall.

In New Jersey, which votes Democratic in presidential races but sometimes puts a Republican in the statehouse, including most recently Chris Christie, the first-term Murphy is liked by most residents, though the coronavirus hit his state and its nursing home populations severely. State Republicans seized on the vaccine rollout’s flaws, particularly its slow pace in reaching long-term care settings even as many doses go unused. That attack line can remind voters of the 7,300 people who died in nursing homes and other long-term care residences when the state was one of the first to be battered last spring.

“Somehow we’ve only distributed 30 percent of our vaccine allotment so far. There are other states at 62 percent so what’s the issue here?” Republican state Sen. Declan O’Scanlon said in an interview. “Plans were in the works for months, supposedly, and yet we haven’t included all the resources that we could to maximize personnel. We know the private pharmacy industry stands ready with almost a thousand individuals certified to give inoculations. Why haven’t we taken advantage of that?”

New Jersey missed a federal deadline that delayed vaccinations by a week, until 103-year-old Mildred Clements became the first person to get the shot on Dec. 28. Murphy, who holds regular Covid-19 press briefings, blamed the delays on the federal government’s complicated reporting requirements and on nursing homes’ deficient information technology. He also said reporting lags paint an incomplete picture of how many vaccines have been distributed. And he has defended the state’s decision to include homes for the developmentally disabled and low income seniors in the first wave, along with the nursing homes themselves.

But Murphy in his State of the State address Tuesday sounded confident that his administration has vaccination on track now.

“We all sense the promise that comes from the arrival of approved, safe, and effective Covid-19 vaccines,” he said. “Despite many obstacles, we have in place a plan to vaccinate every willing New Jersey adult resident — and hundreds of thousands have already rolled up their sleeves.”

In Virginia, Northam can’t run for another term, and several people in each party are vying to replace him. So far, Northam — who is a physician — has fared reasonably well politically for his pandemic response. If that continues it may wash over onto the Democrat who wins the nomination. If he fumbles, it could help Republicans trying to rebuild in a state that’s been trending more Democratic, strategists and spokespeople for both parties said. The Biden administration response to the pandemic may also color what happens across Virginia.

Whether that’s blame or approval, it could “trickle down in state elections,” said John March, a spokesperson for Virginia’s Republican Party.

Jared Leopold, a strategist working for Jennifer McClellan, one of the Democrats seeking the nomination, similarly thinks Northam’s performance will help shape the race — though, from his vantage point, that should help Democrats given that Virginians “appreciate having a doctor at the helm right now.”

“And by the time the campaign peaks next fall, the focus will be turning from response to rebuilding the economy, the health system, education and infrastructure,” he said. “That’s going to be the reality of the conversation.”

And then there’s Newsom. Ten months ago, the California governor, a Democrat with a sky’s-the-limit future, was hailed for decisive early action that seemed to put California on the cutting edge of pandemic control. Now, the world’s fifth largest economy is on its knees. With the virus spreading rapidly, health systems in cities like Los Angeles are buckling under the strain. And the public was outraged when Newsom attended a dinner to fete a lobbyist at a posh Napa Valley restaurant while he was telling everyone else to stay home. The recall movement needs to collect 1.5 million signatures by March 1, and for now, it claims to be on track.

The anger at Newsom, an early advocate of lockdowns, had been building for months; his underperforming vaccination campaign isn’t helping. Newsom has acknowledged that, as of a few days ago, California had administered less than one third of the 2.1 million doses it had received. Flawed IT systems and software failures are partly to blame — even though the state is home to Silicon Valley and the capital of the “innovation economy.” The tech failures in vaccination follow snafus in the state’s infectious disease reporting system this summer that led to underreported tests.

Newsom’s political opponents seized the moment.

“Above and beyond the French Laundry dinner, and the lockdowns — his response and his handling of the vaccine will be his critical point — the make it or break it moment,” said Jennifer Kerns, a former state GOP spokesperson and conservative talk show host. She said the next 60 days will be critical.

Republican former San Diego Mayor Kevin Faulconer, who backs the recall and who has launched an exploratory committee to challenge Newsom said, “There should be nothing more important than to get these shots into people’s arms.’’ He added pointedly, “It’s all about using the full powers of the governor’s office.’’

Even Newsom’s political mentor, former San Francisco Mayor Willie Brown, a Democrat, lambasted Newsom’s vaccine strategy. “The distribution plans, with their various ‘phases’ of who get the virus and when, are too complicated,’’ he wrote in an op-ed column. “It’s time to give the vaccine to anyone in California who wants it,’’ he wrote. That, he said, “would end the recall talk overnight.”

Rolling out his budget Friday, Newsom called for $372 million for vaccinations and promised more flexibility as he aims for one million vaccinations by the end of this week. But he also blamed the Trump administration for a lot of the problems, saying states are the “conduits,” not the deciders. Still, he acknowledged to POLITICO, “At the end of the day, the governor takes responsibility for whatever anyone wants to put on his or her plate.”

In all states, local officials, below the governor, have multiple layers of challenges on vaccination, many of which create political pitfalls. Most decisions about vaccinations are made at the state and federal level, though there are exceptions. When local officials are involved, it’s often public health leaders making the calls.

Still, mayors may benefit if the vaccine drive does well — and they may be the punching bags if it doesn’t, simply because they are right there, the face of a community’s success or failure. New York’s de Blasio, who can’t seek re-election when his term finishes this year, clashed with Cuomo about both vaccine strategy and implementation. Cuomo finally made some significant changes this week, opening up vaccinations to many more residents after previously imposing strict limits that led to massive surplus of Covid-19 shots.

In Florida, where Republican Gov. Ron DeSantis already had been offering the vaccine to people as young as 65, vaccination rates have picked up in the last few days but still aren’t meeting demand. Recriminations are running in all directions.

Democratic mayors like Jane Castor in Tampa and Dan Gelber in Miami Beach are faulting the Trump approach — and said they’ve been doing the groundwork for months, training medical staff and setting up support sites. Castor said they’d even been setting up transportation for the elderly to get their shots, but supplies from Washington were inconsistent, making planning difficult.

“It feels reactive and random,” Gelber said. “There was not a single instruction sent to us from above.” He recalled how much work went into disaster planning when he was staff director of a U.S. Senate investigative committee in the 1990s. “All of this should have been practiced months ago,” he said.

Meanwhile, Sen. Rick Scott (R-Fla.) has demanded a congressional investigation into what he called “vaccine distribution mismanagement,” following multiple reports that a West Palm Beach nursing home and assisted-living facility steered highly sought after vaccine shots to its board members and major donors. He didn’t make that call in consultation with DeSantis, his successor. Both of them are possible contenders for the GOP presidential nomination in 2024.

Experts on vaccination policy expect more political infighting — and more public anger if things don’t go right, or don’t seem fair.

“It’s remarkable about how much this [pandemic] has become a partisan issue,” said Michael Gusmano, who teaches public health at Rutgers University in New Jersey and is also a visiting fellow at the Nelson A. Rockefeller Institute of Government of the State University of New York. But unlike some political finger pointing, “most of what they are pointing at is true.”

“It’s all the problems we are all reading about — the basic infrastructure, coordination,” he said. Health workers are dealing with a huge post-holiday surge of patients, sky-high demand for testing — and “really complicated vaccine distribution.”

People are confused when the rules are different from one state — or sometimes even one hospital system — to another, particularly when it’s just not made clear why.

“All states have prioritized health care workers. But they aren’t defining it the same way,” said Jen Kates, a senior vice president of the Kaiser Family Foundation who has been focusing on the immunization drive.

And the confusion spurs anger, a sense of unfairness.

“If people don’t understand, if they don’t see it as fair, they get mad at all levels. At the governors. The health departments. The health care institutions. They’ll get made at everyone.,” said Rekha Lakshmanan, director of Advocacy and Policy for The Immunization Partnership in Texas and a fellow at the Baker Institute for Public Policy at Rice University.

That’s where the vaccine stars — the politicians who can achieve a Cuomo-like clarity combined with compassion — can thrive, Gusmano said.

“Cuomo got credit for calm, clear communication” early in the pandemic, he said. “You can go a long way by not making it seem like things are happening randomly and arbitrarily.” Even if sometimes they are.

Carla Marinucci, Sam Sutton, Amanda Eisenberg, Shannon Young and Arek Sarkissian contributed to this report.