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Who will get the first coronavirus shots?

The sting that everyone wants in their arm. A photo illustration of a coronavirus vaccine.JOEL SAGET/AFP via Getty Images

A panel of experts that advises the US Centers for Disease Control and Prevention is pondering a recommendation that health care workers and residents of long-term care facilities get coronavirus vaccines first, followed by essential workers, and then a much larger group comprising high-risk medical conditions and adults 65 and older, according to published reports.

The Advisory Committee on Immunization Practices discussed the vaccine distribution plan at a meeting Monday but has not voted on it yet.

STAT reported that there was clear support on the panel for moving essential workers closer to the front of the line for the vaccines that could be available as soon as next month.


“These essential workers are out there putting themselves at risk to allow the rest of us to socially distance. And they come from disadvantaged situations, they come from disadvantaged communities,” said Beth Bell, a global health expert from the University of Washington who is on ACIP and chairs its COVID-19 work group studying the vaccines.

Recently, promising results have been announced by several vaccine makers, including Pfizer, which is applying for emergency use authorization, and Moderna, which says it will seek one. Those approvals could come from the US Food and Drug Administration in December

Once the FDA OK’s new vaccines, the vaccine committee will meet and issue its recommendations. CDC director Robert Redfield is expected to sign off on the recommendations immediately, clearing the way for vaccination efforts to begin, STAT reported.

But US Health and Human Services Secretary Alex Azar said Tuesday that the federal government won’t wait for the committee’s recommendations before shipping the first shots. He also said states will have the final say on how to prioritize their vaccines, Politico reported.

Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, said, “From an [infectious disease specialist’s] perspective, we have always valued greatly the input of the ACIP to set vaccine guidelines, as they try to bring the best evidence to inform the recommendations they make. That said, since every state is different, we should expect there will be a certain amount of variability from state to state on how the vaccines are deployed.


“In other words, I don’t expect states to ignore the ACIP recommendations — just to adapt them best to suit their local and regional needs,” he said in an e-mail.

Massachusetts has been working on its plan to distribute the vaccines.

In a paper published Monday, the advisory committee said that “planning scenarios estimate … that the expected number of doses during the first weeks of vaccine distribution might only be sufficient to vaccinate approximately 20 million persons.”

The paper said there was a “clear consensus” that the first allocation should go to health care workers but discussion of allocation to other groups was “ongoing.”

STAT and other media reported that the committee at its Monday meeting discussed adding residents of long-term care facilities to the health care workers in the first group.

The paper, published in the CDC’s Morbidity and Mortality Weekly Report, laid out the ethical principles the committee said would help it in making its recommendations and “state, tribal, local, and territorial public health authorities in developing vaccine implementation strategies” based on their recommendations.


The four ethical principles are 1) maximizing benefits and minimizing harms; 2) promoting justice; 3) mitigating health inequities; and 4) promoting transparency, the committee said.

“In the setting of a constrained supply, the benefits of vaccination will be delayed for some persons; however, as supply increases, there will eventually be enough vaccine for everyone,” the report said.

“Although the ethical principles in this report are fundamental for stewardship of limited vaccine supply, they can also be applied when COVID-19 vaccines are widely available, to ensure equitable and just access for all persons,” the report said.

The 20 million doses coming in the first weeks of distribution will only be a fraction of what is needed, considering that, according to committee estimates, there are 21 million health care workers, 87 million essential workers, more than 100 million adults with underlying health problems and 53 million people aged 65 and up. The committee noted that there was considerable overlap among the groups, such as older people who might have underlying health problems.

Jeremiah Manion of the Globe staff contributed to this report.

Martin Finucane can be reached at martin.finucane@globe.com.