Vaccine Distribution Order


Nina Kini, Public Health Editor/Contributing Writer, Placentia CA

 Millions of people worldwide tuned in on November 9, 2020 to hear Dr. Albert Bourla (Pfizer Chairman and CEO) announce that Pfizer’s Covid-19 vaccine had successfully completed phase 3 clinical trials with more than 90% efficacy in preventing the Covid-19 disease. For many people, it was a time of elation. It served as a rare moment of inner peace; knowledge that the end of one of the most brutal pandemics in the last century was actually in sight. After a year of pain, suffering, and frustration, it seemed like human ingenuity had finally managed to win out. Exactly one week later, the drugmaker company Moderna also announced that early trials of their vaccine showed nearly 94.5% efficacy (Grady). With the arrival of the ‘miracle vaccines’ though, came a whole new flurry of questions.

Among the top, how on Earth are we going to be able to distribute the two necessary doses of the vaccine to nearly 330 million Americans in a reasonable amount of time? Clearly, this will be one of the most challenging logistical undertakings of the U.S. government in history. In order to maximize effectiveness, officials quickly realized that they would need to create a prioritization-order for vaccine distribution. That way, people who needed it most would get it first. So what exactly does this distribution-order look like, and why?

Local Distribution 


The order of distribution is primarily based on two things. First, direct Covid-19 exposure. People who come in contact with lots of Covid-19 patients in their day to day lives are at a much higher risk of contracting the virus. This mainly applies to healthcare workers on the frontline. Emergency Room doctors, nurses, EMTs, and other personnel that spend most of their day treating and helping Covid-19 patients have the highest chance of contracting the disease and developing life-threatening symptoms (California). With many hospitals veering towards 100% ICU capacity as well as new shortages of PPE, frontline healthcare workers have been placed at the top of the priority list in most states. The second key factor in determining distribution order is vulnerability. This refers to Americans who are at highest risk of ending up in the hospital with life-threatening symptoms as a result of contracting the virus.  In most cases, the elderly are the first to fall into this category. People over the age of 75, especially those who aren’t in very good health, are at the highest risk of actually dying upon getting sick with Covid-19. Long term nursing home patients have been particularly subject to this kind of issue, with many of them having chronic illnesses that compromise their immune system capabilities (California). In addition to that, they are often cared for solely by the nursing home staff, many of whom are much younger and therefore frequently catch Covid-19 while socializing outside of work. While the virus might not do much harm to the young staff members, once it is transmitted to the elderly nursing home patients, their lives can easily be put in jeopardy. For that reason, residents of Long-Term Care Facilities are also high up on the list for receiving the vaccine. 






Political Figures 


Anyone who’s been watching the news in the past couple of weeks might have seen the various political figures publicly receiving the vaccine; including Vice President Pence, President-Elect Bide, Vice President Elect Harris, and numerous members of the House of Representatives and Senate. Some may be wondering why this is the case, since none of those listed are frontline healthcare workers or residents of nursing homes. The reasons for this are varied. All members of the U.S. Congress were allowed to receive the vaccine at the earliest convenience to help ensure  “continuity at the highest reaches of the U.S. government” (Politicians). Some of them who immediately took advantage of the opportunity argued that getting the vaccine in public would instill a sense of trust and confidence in the vaccine, and help dissuade people from doubting its legitimacy. Others who opted to wait longer before getting inoculated countered that they should give priority to those who really needed it the most- the frontline healthcare workers and vulnerable elderly. Either way, it goes to show how important the issue of vaccination has become for all Americans. 


Global Disparities


While many in the U.S. are concerned about when they’re going to get the vaccine, many residents of developing countries aren’t sure whether or not they’ll get it at all. It’s no secret that the development of the Covid-19 vaccine was not cheap. The Pfizer vaccine costs about $20.00 per dose, and the Moderna is around $35.00 per dose. As with many other pharmaceuticals, high-end medical drugs are usually just sold to the highest bidder. This accounts for a disastrous global distribution disparity. All 27 countries of the European Union, as well as 5 other rich countries have managed to pre-order nearly 50% of the projected vaccine output for the next few months- and these countries account for just about 13% of the global population (Mullard). Undoubtedly, the inequity is bound to result in disproportionate death and sickness in countries who can’t afford to pay for the expensive new vaccines as opposed to those who can. Even if it was eventually possible for them to buy the necessary vaccine doses, distribution would be extremely difficult. Both the Pfizer and Moderna vaccines require super-freezing all the way up until usage. The optimal temperatures for both of them is less than -70 degrees Fahrenheit (colder than Antarctica). Just to maintain this temperature, the vaccines need to be kept in specially designed freezers, which are not easy to transport over rough terrain or without a steady power supply. For that reason, it will most likely be near-impossible to get them out to remote, isolated communities in developing countries. Luckily, the recently approved UK Astrazeneca vaccine “can be stored and transported at normal refrigerated temperatures of 2 degrees to 8 degrees Celsius (36 degrees to 46 degrees Fahrenheit) during transport, giving the shot a major logistics leg up over a leading mRNA-based competitor” (Blankenship). Although the Astrazeneca vaccine’s efficacy hovers only between 60 and 70%, at just under $4.00 per dose it’s still an important step forward for developing countries who are looking for a more logistically and financially efficient alternative. Despite the best efforts, numerous cases of foul-play in vaccine consumption have already been discovered. In southern California, doctors in high risk counties have reported hundreds of phone calls from their wealthiest clients to see if “they can have early access to the extremely limited supply of vaccine doses in exchange for a financial contribution to a hospital or charity” (ABC7 LA). Many health officials worry that in such trying times, the race to get inoculated might give way to an illegal vaccine blackmarket. Although some might consider this a reach, any situation in which vaccines are delivered and used without appropriate precautions and health personnel present could lead to dangerous mistakes and the possible loss of trust in the health care system. 


So When Will I Get the Vaccine? 


At the end of the day, many average people are enthusiastic and excited to get their first dose of the vaccine, and move one step closer to ending the pandemic for all. For the time being though, the best advice that the majority of public health officials have for the general public is to be patient. Once the vaccine has been distributed to all frontline healthcare workers and nursing home residents, distribution will move towards essential workers and people over the age of 75. Although the general idea is the same across the country, each state has outlined its own unique plan for distribution. Most of them are closely following the guidelines outlined and recommended by the CDC. These guidelines state that after healthcare workers and residents of long-term care facilities are inoculated, the focus should move towards “fire fighters, police officers, corrections officers, food and agricultural workers, United States Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and those who work in the educational sector (teachers, aids, daycare)” (CDC).  All of the people in the positions listed above tend to come in contact with large portions of the general population on a day to day basis as part of their job. They are also crucial for running ‘essential resources’ such as fire stations, prisons, food banks, grocery stores, public transport, and schools. Because of their high exposure risk and importance to societal functioning, these essential workers are likely to be vaccinated in the first few months of 2021. Afterwards, the vaccine priority will move down to successively younger groups of people, as well as those with underlying medical conditions like autoimmune disorders, cancers, diabetes, asthma, etc. It’s hard to predict the exact date when a vaccine will be available for an individual group of people. As said before, the whole national undertaking of vaccine distribution is not easy.

There are likely to be set-backs, obstacles, and logistical errors. As of late December 2020, only about 3 million people in the U.S. have been vaccinated for Covid-19 (NY Times). That’s just under 1% of the total population (mostly consisting of frontline health care workers and nursing home residents). According to Dr. Anthony Fauci (director of the National Institute of Allergy and Infectious Diseases and leading figure in the Coronavirus task force), if the vaccine distribution program is vigorous enough and manages to get vaccines out to 75-80% of the U.S. population by the summer of 2021, then there might be some hope of semi-normalcy by the end of 2021 (Powell). Until the majority of people in the U.S. are vaccinated though, it is still crucial to continue social distancing and mask usage. Clearly, the road to success is not an easy one. The recent vaccine approvals have become a light at the end of the tunnel to many who have faced hardship and difficulty during the Covid-19 pandemic. Although the transition back to ‘normal life’ won’t come immediately, there is hope for the future. 


Works Cited

Blankenship, Kyle. “AstraZeneca Hopes Warmer Storage Needs for COVID-19 Vaccine Will Be an Advantage against MRNA Competitors.” FiercePharma, 23 Nov. 2020,’s COVID-19 vaccine candidate,logistics leg up over a.

California, State of. “Vaccines.” Coronavirus COVID-19 Response,

Grady, Denise. “Early Data Show Moderna’s Coronavirus Vaccine Is 94.5% Effective.” The New York Times, The New York Times, 16 Nov. 2020,

Mullard, Asher. “How COVID Vaccines Are Being Divvied up around the World.” Nature News, Nature Publishing Group, 30 Nov. 2020,

Person. “Coronavirus Vaccine: Wealthy Patients in Southern California Offering Top Dollar to Cut in Line.” ABC7 Los Angeles, KABC-TV, 19 Dec. 2020,

“Politicians Getting Vaccinated: Setting an Example or Cutting in Line?” Los Angeles Times, Los Angeles Times, 24 Dec. 2020,

Powell, Alvin. “Anthony Fauci Offers a Timeline for Ending COVID-19 Pandemic.” Harvard Gazette, Harvard Gazette, 11 Dec. 2020, & Medicine-,Fauci says herd immunity possible by fall, ‘normality’ by,of Allergy and Infectious Diseases.

The New York Times. “Nearly 2.8 Million People in the U.S. Have Gotten a Covid-19 Vaccine.” The New York Times, The New York Times, 17 Dec. 2020,

“When Vaccine Is Limited, Who Gets Vaccinated First?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention,


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