By Peter Loftus, Melanie Grayce West and Jared S. Hopkins

The first U.S. Covid-19 vaccinations outside of clinical trials began Monday, kicking off the most urgent mass immunization campaign since polio shots were rolled out in the 1950s.

A nurse in New York was among the first to receive the shot, and health workers throughout the U.S. were also set to receive the newly authorized vaccine developed by Pfizer Inc. and BioNTech SE. Pfizer shipped vaccine vials out Sunday, and hospitals and health departments across the country received them early Monday.

A total of 55 sites nationwide had received vaccine shipments by around noon on Monday, said Gen. Gustave Perna, chief operation officer for Operation Warp Speed, the U.S. government's coronavirus-response program. He said at a press conference that plans remain on track for a total of 636 locations to receive vaccines by Wednesday and an additional 581 between Thursday and Sunday, completing distribution of an initial 2.9 million doses. The vaccines are given in two doses several weeks apart.

The government has a reserve of 500,000 doses in case any problems arise, he added.

The largest past immunization campaigns in the U.S. were launched during smaller outbreaks or as preventive measures over many years to try to eradicate a persistent pathogen. The Covid-19 effort "will be logistically and socially and medically the largest unfolding of a vaccination program ever conducted," said Dr. Howard Markel, professor of medical history at the University of Michigan. "We've never had such a massive campaign in the middle of a pandemic."

Public-health officials have been counting on a vaccine's arrival to help bring an end to the deadly pandemic, which has killed just under 300,000 Americans and infected 16.25 million since it started spreading, according to data collected by Johns Hopkins University. The virus has surged in recent weeks, setting new records for the number of daily new cases and deaths, and prompting new rounds of government restrictions on activities in an attempt to slow the spread.

The first Covid-19 vaccination in New York City was administered shortly after 9 a.m. Monday morning to Sandra Lindsay, a critical care nurse at Long Island Jewish Medical Center in Queens.

UPMC Children's Hospital of Pittsburgh vaccinated several of its front-line workers during an event that was streamed live online Monday, after it received about 975 doses.

The University of Michigan's health system said it received 1,950 doses of Pfizer's vaccine and planned to do a small number of vaccinations Monday, followed by more on Tuesday.

In California, the most populous state, Gov. Gavin Newsom was scheduled to attend the first vaccination of a state resident at a hospital in Los Angeles County Monday afternoon.

Hospitals in many other states, from Oregon to North Dakota, also received their first vaccine doses Monday. Some were set to begin injecting patients immediately, while others needed some time for logistics such as distributing the vials and training staff.

Medical staff have been advised to monitor patients who receive the vaccine for at least 15 minutes to make sure they don't have adverse reactions. Two people who received the Pfizer vaccine in the U.K. last week had severe allergic reactions. The additional time required for monitoring, as well as some logistical hiccups, have slowed the vaccine rollout in that country.

Following CDC guidelines, the soonest that residents of long-term care facilities can get the vaccine will be Dec. 21, but Health and Human Services Secretary Alex Azar said there is "no prohibition" for it to begin earlier.

Only a small percentage of the population will get access to the shots initially, as early supplies are limited. Pfizer is shipping a total of nearly three million doses in this first wave. They are going to states based on their populations, with most receiving enough doses to inoculate a little less than 1% of their populations.

Pfizer has said 25 million doses will be available in the U.S. by the end of the month.

Mr. Azar said at a Monday press briefing that the federal government was withholding some doses of the Pfizer vaccine to ensure there would be enough supply so that people can get their booster shot three weeks later. He also said supply will depend on when Pfizer releases more doses and when they are available.

"We need to make sure that if we vaccinate someone a first time that we expect there to be a vaccine for a booster on the 21st day or the 28th day, either from a held-back supply at the federal level or ongoing new production," Mr. Azar said.

Pfizer's second shot is given three weeks later; a similar vaccine from Moderna Inc. is four weeks later.

If Moderna's Covid-19 vaccine is authorized later this week, it could add to the supply of doses this month. Plans call for it to be shipped to 3,285 sites, more than five times as many as those receiving the Pfizer vaccine, Gen. Perna said, because the government has had more time to plan for its rollout.

The federal government is using contractors to ship Moderna's vaccine, while Pfizer is being distributed by the drugmaker itself.

As the initial supplies are limited, the first doses are being reserved for doctors, nurses and other front-line health workers who might be exposed to the coronavirus while caring for infected patients.

Residents of nursing homes and other long-term care facilities also are expected to get early doses, because they are more vulnerable to severe Covid-19 disease and death.

Gen. Perna said he expects to see the vaccine go to nursing homes this week.

Eventually, as supplies increase, more priority groups, such as essential workers and the elderly, will be vaccinated.

Federal officials expect about 100 million Americans to be immunized against Covid-19 by February or March. The general public could be inoculated in the spring or summer.

The U.S. Food and Drug Administration authorized the Pfizer-BioNTech vaccine on Friday last week, citing its 95% effectiveness at preventing symptomatic Covid-19 in a large clinical trial. On Saturday, an advisory committee to the U.S. Centers for Disease Control and Prevention voted to recommend that the vaccine be used for people 16 years and older.

Cedars-Sinai Medical Center in Los Angeles expects to receive its first doses Monday and start administering shots to most workers Tuesday or Wednesday, Chief Operating Officer Dr. Jeffrey Smith said.

"It's a little bit challenging because, of course, we're dealing with a surge of patients at the same time we need nurses to help administer the vaccine," Dr. Smith said. "It's an extra layer of complexity."

At the Sanford Broadway Medical Center in Fargo, N.D., Jesse Breidenbach, senior director of pharmacy for Sanford Health, pulled into a parking lot around 7 a.m., expecting the Covid-19 vaccine to be delivered later that morning.

His phone rang. The vaccine had already arrived, a pharmacist told him. "What?" Mr. Breidenbach thought as he darted through the 4 degree morning air. "None of us had received a text update it was in transit."

Employees filled all 142 slots available for vaccinations scheduled to begin in Fargo Monday afternoon, a spokeswoman said.

--Christine Mai-Duc, Joe Barrett, Melanie Evans and Kris Maher contributed to this article.

Write to Peter Loftus at peter.loftus@wsj.com, Melanie Grayce West at melanie.west@wsj.com and Jared S. Hopkins at jared.hopkins@wsj.com

(END) Dow Jones Newswires

12-14-20 1547ET