UPDATE: This story has been updated to reflect the latest information shared by the North Carolina Department of Health and Human Services and Orange County Health.

The Orange County Health Department has not received any first dose allotments of COVID-19 vaccines from the state for three weeks in a row.

The local department shared a release on Monday with the details, saying this lack of new doses will severely hamper any efforts to schedule new appointments for vaccination through Orange County’s government.

“As of January 24, 2021, all first doses of vaccine have been exhausted and it is not clear when we will be receiving more vaccine from the state,” said Orange County Health Director Quintana Stewart.

The department said the lack of first dose allotments of vaccines will not delay the second vaccines for community members who have already received their first shot. Stewart said it will be “weeks or perhaps months” until Orange County can complete vaccinations for Phases One and Two.

“We understand this must be frustrating for our community members to hear and we want let you know that we share in your frustration,” she said.

North Carolina is currently under Phase Two of vaccine distribution, which is open to any resident 65 years and older regardless of health or living condition. According to Orange County, around 22,000 residents in the county are eligible in this distribution phase.

Orange County is not the only place seeing a shortage in its first-time doses. UNC Health echoed similar on Monday, saying it will receive only 10,000 doses of COVID-19 vaccine from the state for this week. For UNC Health entities across the state, this represents less than half of the allocation anticipated by leadership, since the healthcare system has the ability to administer about 30,000 shots a week.

Several outlets reported Monday this decline in shot doses could be caused by the state government shifting its vaccination efforts to more mass clinics instead of through hospital systems or local health departments. Additionally, the Associated Press reports the North Carolina Healthcare Association sent Governor Roy Cooper a letter on Monday criticizing the changes guidance and asked for clearer strategies.

The North Carolina Department of Health and Human Services is set to provide a public update to the state on these efforts on Tuesday. Dr. Mandy Cohen, Secretary for NCDHHS, said in a statement Monday vaccine supply shortages from the federal government are influencing the lack of new doses on the local government and healthcare system level.

“As long as we are getting such a small amount of vaccine as a state,” Cohen wrote, “there are going to be challenges and shortages as we try to ensure equitable access to vaccine, while getting shots into arms quickly. We understand this is hard for providers who are doing everything right.”

A spokesperson for the Orange County Health Department said in response to a message from the North Carolina Association of Local Health Directors, state health leaders also guaranteed a minimum allocation amount that will be sent to county governments and hospital systems for the next few weeks. Reporting from WRAL confirms this, although specific amounts of these allocations are unknown at this time.

As of January 22, the Orange County Health Department reports administering 3,024 first doses of the COVID-19 vaccine and 537 of the second dose. NCDHHS reports 14,677 total doses having been administered in Orange County as of January 21.

“Vaccines give us great hope that we can return to a more normal existence in 2021,” said Stewart on Monday, “but we are currently living through the most difficult and deadly part of the pandemic. Please keep your guard up against this virus until we can all be vaccinated.”

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