Army Brig. Gen. Deydre Teyhen, right, and Navy Capt. Melissa Austin receive a COVID-19 shot Oct. 10, 2023, at Walter Reed National Military Medical Center in Maryland. The latest COVID-19 shots are just now arriving for service members, Defense Department civilians and their families at some locations in Europe. (Ricardo J. Reyes/Walter Reed National Military Medical Center)

KAISERSLAUTERN, Germany — The U.S. military hasn’t been in a rush to offer updated COVID-19 vaccines to service members and their families overseas, nearly three months after the shots became available stateside.

The Defense Department has had trouble ordering the shots commercially, and its main contractor, Pennsylvania-based Cencora, doesn’t have the facilities yet to store a major brand of the shot at the required temperature, military health officials said.

While flu shots are widely available on bases — they’re mandatory for service members and recommended for others — coronavirus vaccinations are optional.

And although the severity of the illness has declined for most people since the heights of the pandemic, it still is making people sick, especially as they come into close indoor contact during winter. The U.S. Centers for Disease Control and Prevention recommends the updated shot for people ages 6 months and older.

The vaccines aren’t available at Ramstein Air Base in Germany, which is part of the largest overseas U.S. military community.

“At this time, we are not concerned with the delays, as the demand for previous vaccinations for COVID boosters was not high,” the 86th Medical Group at Ramstein Air Base said Friday in a statement.

The medical group says it hasn’t been recommending that vulnerable people seek the vaccination from a German doctor or while in the U.S., because the military’s Public Health Command-Europe hasn’t seen an increase in cases in the area.

Influenza vaccines and COVID-19 shots are prepared on Marine Corps Base Camp Lejeune, N.C., in November 2022. In Europe, flu vaccine has been readily available to personnel linked to the U.S. military, but the latest COVID-19 booster shots are sporadically available on the Continent. (Adam Scalin/U.S. Marine Corps)

Cases in Germany have risen from 11 per 100,000 people at the beginning of October to 29 per 100,000 people as of this week, according to Germany’s federal portal on COVID-19 activity. While those figures are far from the highs of the pandemic, health officials acknowledge fewer people are getting tested and reporting their illnesses.

The U.S. saw nearly 20,000 hospitalizations related to the coronavirus over the week ending Nov. 25, according to the most recent CDC report.

Landstuhl Regional Medical Center, the largest DOD hospital overseas, said Monday it had received its first batch of the vaccine.

The Army hospital near Ramstein is offering the updated shot on a walk-in basis on seven dates this month, according to a Facebook announcement Monday.

Each clinic ordered the vaccine independently based on expected demand and patient population, hospital spokesman Marcy Sanchez said.

Shipment delays have affected military medical clinics in Europe, he said, noting that all orders across the Continent were placed at about the same time.

The Pfizer vaccine is available in Wiesbaden, about an hour from Ramstein, for those ages 12 and older. And in Sicily, the Navy is offering the Pfizer shot for children ages 6 months to 4 years old and for those 12 and older.

The Navy in Naples, Italy, is awaiting its Pfizer vaccines and will offer them to active-duty service members on a walk-in basis, naval hospital spokesman Todd Folts said. The rest of the community will be able to walk in and get them the following week, he said.

A person receives a COVID-19 shot at Ramstein Air Base, Germany, in January 2022. The latest COVID-19 shot is unavailable at the base and has just arrived at nearby Landstuhl Regional Medical Center. (Jared Lovett/U.S. Air Force)

The shots also have been sporadically available at bases in Japan and other parts of Asia.

The U.S. government stopped buying and dispatching the vaccine in bulk this summer, transferring the program to private companies.

The contractor Cencora sends the vaccine to stateside locations on most weekdays, but overseas shipments “are restricted to fewer days and choreographed to avoid stranding them,” Defense Logistics Agency spokeswoman Michelle McCaskill said in a statement last week.

Cencora is unable to store the Moderna shot, which is one of three approved for COVID-19.

In a statement on Monday, Cencora said it would “work closely with all of our customers to address their needs and enable timely and reliable access to COVID-19 vaccines.”

The updated Moderna vaccine needs to be frozen until its expiration date or refrigerated between 36 and 46 degrees Fahrenheit for up to 30 days before being discarded.

“Military hospitals and clinics have been given the option to change their orders to Pfizer or Novavax, which are readily available,” the Defense Health Agency said in a statement last month. “Some military hospitals and clinics have made this choice; others have said they’ll wait for Moderna.”

The military services pay about $860 for 10 adult doses of the Pfizer and Moderna vaccines. The Novavax vaccine costs $583 for five adult doses, according to DLA.

Stateside, interest in updated vaccines has been tepid. About 14% of adults have received the updated jab since September, compared to 28% vaccinated so far against influenza, Voice of America reported last month.

Stars and Stripes reporter Alison Bath contributed to this report.