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The coronavirus pandemic has taken a toll on the United States' immunization managers, USA Today reports.

Since COVID-19 first took hold in the U.S., 14 managers have quit, four were promoted, and six retired, reportedly most earlier than planned. All told, 24 of the 64 people who oversee the country's vaccination programs have left. Normally, the yearly turnover is about 10 people, Claire Hannan, the executive director of the Association of Immunization Managers, said.

The fact that the figure more than doubled in the last year isn't entirely surprising — the managers battled burnout amid the U.S.'s largest ever vaccination campaign, which was heavily politicized at times. But it is concerning, Dr. Walter Orenstein, the director of the Emory University Vaccine Center, told USA Today, explaining that individual immunization managers have built personal relationships over the years with leaders at the state and local levels, something that will likely be tough to replace. "What works and what doesn't work in each community may be somewhat different," Orenstein said. "That's why it's so important to have people at the state and community level who have experience." Read more at USA Today.