Health officials are worried that Hawaii might not have enough COVID-19 vaccines to sustain large-scale immunization clinics, two of which are opening within the next two weeks.

The Healthcare Association of Hawaii, which represents the state’s hospitals and nursing homes, is especially concerned since there is no indication week by week as to how many doses the state will actually receive. That means the ramp-up of mass vaccinations could be slower than anticipated.

The state is partnering with Hawaii Pacific Health — parent company of Kapiolani Medical Center for Women & Children, Straub Medical Center, Pali Momi Medical Center and Wilcox Health on Kauai — to roll out immunizations to at least a thousand people at Pier 2 on Monday, and with The Queen’s Medical Center a week later at the Neal S. Blaisdell Center.

“We do not have any assurance there’s enough vaccines coming into the state to sustain these large pods,” Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, told the Honolulu Star-Advertiser. “We only know literally days in advance what we’re going to get. If we’re only getting 20,000 doses a week and it’s got to go through the whole state — not just Honolulu — then there’s no way that these pods will be able to keep going.”

Hawaii Pacific Health said it has assembled 20,000 doses to start vaccinating seniors 75 and older, first responders and front-line essential workers by appointment only. On Wednesday about 1,000 people had already been scheduled to be first in line when the large vaccination site opens.

Statewide, more than 40,000 individuals had been inoculated with at least one dose as of Wednesday, and 109,250 doses had been delivered in the islands, according to the Department of Health.

“It is not in our control,” said DOH spokeswoman Janice Okubo. “We’re hoping to be able to meet the demand, but we are kind of constrained by what we receive from the federal government and the guidance we receive from the federal government, which does seem to change fairly often. It’s a huge balancing act … because we’re looking at multiple islands, we’re looking at multiple partners and we’re trying to make sure that each of the groups gets covered. The elderly population, it is a challenging population because they have mobility issues … and we want to make sure we cover them because they’re our most vulnerable population.”

Hawaii Pacific Health said it will begin vaccinating more than 1,000 people a day and increase that in the next few weeks to between 3,000 and 4,000. Queen’s plans to start with 2,000 inoculations a day at the Blaisdell and expand to 3,000 to 4,000 per day within a week or two. Both have set goals of eventually being able to vaccinate 5,000 per day.

“We acknowledge the uncertainty of the vaccine supply, which is why we have made the decision to only schedule appointments when we have a confirmed supply. We will open up appointments gradually to deal with this issue,” said Melinda Ashton, chief quality officer at Hawaii Pacific Health.

Lt. Gov. Josh Green earlier told the newspaper that the state hopes to administer as many as 100,000 shots this month and up to 150,000 doses monthly in February, March, April and May. But Raethel said 150,000 shots is “not a validated number” since there’s “no guarantee” how many doses will actually be distributed to Hawaii.

“It makes it challenging when we’re talking about scheduling these clinics and having staff to do the clinics. It’s a wishful number,” he said.

With significant demand, Raethel is trying to lower public expectations on how many people will actually be able to get vaccinated.

“The last thing we want is for hundreds of people to show up at these pods … then we say, ‘Well, whoops, we don’t have the vaccine,’” Raethel said, adding that health officials only found out at 3 p.m. Sunday how many actual vaccines would be arriving in the islands Monday. He said the large sites will likely be able to increase inoculations to around 2,000 per day, but not much more at this point. “We can’t plan out three weeks, four weeks or even two weeks in advance. It’s incredibly frustrating for people, I understand.”

Health officials reported six new coronavirus-related deaths on Thursday — five on Oahu and one on Maui — and 179 new infections, bringing the state’s totals since the start of the pandemic to 318 fatalities and 23,908 cases.