How Will the COVID-19 Vaccine Be Distributed?

covid distribution

Verywell / Brianna Gilmartin

Key Takeaways

  • The first phase of COVID-19 vaccine distribution, which began in December, will prioritize healthcare workers, residents of assisted living facilities, essential workers, adults ages 65 and older, and people ages 16 to 64 with high-risk medical conditions.  
  • The Centers for Disease Control and Prevention officials issued preliminary guidelines in December.
  • State and local health departments are managing distribution, and states are determining order of eligibility.
  • President Joe Biden announced that states will be directed to make all adults eligible for vaccination by May 1.

State and local health departments are determining how the COVID-19 vaccines are being distributed and all followed the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices' (ACIP) guidance to put healthcare workers and residents of assisted living facilities (such as nursing homes) at the front of the line.

In about one-third of states, additional groups were eligible for vaccination in the initial rollout, diverging somewhat from the CDC's recommendations. As of March 15, most states had diverged from the ACIP guidance in some way.

On January 12, the Department of Health and Human Services announced at a press briefing that vaccination should begin for people 65 and older and those with underlying medical conditions that are considered high risk for COVID-19. Prior to taking office, President Joe Biden also announced plans to increase eligibility, including to those 65 and older. Many states adjusted their priority groups in the weeks that followed these announcements.

On March 11, President Biden announced that states will be directed to make all adults eligible for vaccination by May 1.

The guidance for vaccine eligibility is changing quickly and many kinks in distribution still need to be worked out, but experts tell Verywell it’s possible that life could be well on its way back to normal by summertime. 

“Assuming we still are good about masking and social distancing [and] we're able to meet the challenges of distribution and update, and assuming that there are no serious adverse events that occur...then slowly but surely, we should find a lesser and lesser degree of disease and hospitalization and death,” Paul Offit, MD, professor of vaccinology at the University of Pennsylvania’s Perelman School of Medicine, tells Verywell. 

What This Means For You

If you do not meet any of these criteria put forth by the ACIP, you may have to wait until after May 1 to get the COVID-19 vaccine. 

How Was the Plan Introduced? 

The CDC plan, titled “Phased allocation of COVID-19 vaccines,” was presented at an emergency meeting of ACIP on December 1. This was two days after the biotechnology company Moderna requested an emergency use authorization (EUA) for its vaccine from the Food and Drug Administration (FDA). (The agency granted an EUA for the Pfizer-BioNTech's vaccine on December 11 ,an EUA for the Moderna vaccine on December 18, and an EUA for the Johnson & Johnson vaccine on February 27. AstraZeneca has yet to request one.) 

While far from set in stone, the plan provided insight into what CDC leadership was thinking at a critical juncture in the pandemic. 

“Making adjustments as needed will definitely happen,” Offit says. “I think it's going to be a real learning curve here in the first few months until people get comfortable with how this is going to work best.” 

Developed by Kathleen Dooling, MD, MPH, a CDC co-leader of the ACIP COVID-19 Vaccines Work Group, the plan relies on a staggered model of vaccine distribution that adheres to several core ethical principles:

  1. Maximize benefits and minimize harms
  2. Promote justice
  3. Mitigate health inequities
  4. Promote transparency

The model is divided into several phases and subphases, but the plan, at least in its current incarnation from an ACIP meeting on December 20, focuses mainly on Phase 1a, 1b, and 1c. This is likely because “limited vaccine supplies force ACIP to prioritize the vaccine distribution only to the populations identified in Phases 1 a, b, and c for now,” Zucai Suo, PhD, professor of biomedical science at the Florida State University College of Medicine, tells Verywell. 

Who Will Get Vaccinated When? 

Timelines and vaccine eligibility vary by state with some states adhering fully to the order of the ACIP's subgroups in Phase 1 and others diverging from it.

In the CDC's Phase 1a, those to receive the vaccine include:

  • Healthcare personnel
  • Long-term care facility residents

As of March 15, more than two-thirds of states diverged from the ACIP guidance for Phase 1a, such as including more groups, and almost all states (47, plus the District of Columbia) diverged from the ACIP guidance for Phase 1b, according to the Kaiser Family Foundation.

In the CDC's Phase 1b, which focuses on frontline essential workers, those who will receive the vaccine include:

  • Teachers
  • Firefighters
  • Police officers
  • Corrections officers
  • Food and agricultural workers
  • Public transit workers
  • Teachers and school staff and daycare workers
  • People ages 75 and older

Phases 1b and 1c may overlap, according to the CDC.

During the CDC's Phase 1c, the vaccine will be made available to:

  • Adults ages 65 and older
  • People ages 16 to 64 with high-risk medical conditions, such as cancer, diabetes, obesity, cardiovascular disease, and chronic respiratory disease
  • Other essential workers, such as transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety, and public health

The target demographics were chosen based on their level of risk and their importance to the continued functioning of the economy and society. Long-term care facility residents, for example, accounted for the vast majority—40%—of all COVID-19 deaths as of November 2020.

According to the results of an online poll cited in Dooling’s report, the majority of American adults appeared to approve of ACIP’s recommendations, ranking healthcare workers and older adults as highest-priority and children and young adults as lowest-priority.

How Many Doses Are Needed?

Dooling estimates there are around 21 million healthcare personnel in the United States and 3 million long-term care facility residents. The plan does not provide an estimate for the number of people who will be vaccinated in Phase 1b or 1c, but Suo believes essential workers to number around 26 million people and older adults and immunocompromised individuals to number over 100 million people.

Suo's initial estimates for Phase 1a, which were based on the two-dose vaccines from Pfizer and Moderna, were that it would require at least 48 million doses; Phase 1b would require about 52 million doses and Phase 1c would require over 200 million doses for a total of roughly 300 million doses. Now that a single-dose vaccine from Johnson & Johnson is authorized and also commercially available, the total vaccine doses drop and should fall between 100 to 200 million for phase 1c, according to Suo's estimates.

Next Steps 

The companies that receive EUAs from the FDA will need to manufacture and distribute the number of required vaccine doses to clinics, hospitals, and pharmacies throughout the country and workers will need to administer them. 

But that is easier said than done. There are several barriers to distribution and administration, including but not limited to production rate and storage requirements. 

“[Phase] 1a, 1b, and 1c include probably about 150 million Americans," Suo says. In addition, he says, “the Pfizer vaccine has difficult storage, handling, and shipping requirements, because of the need for dry ice.”

On February 25, 2021, the FDA announced that the Pfizer-BioNTech vaccine could be transported and stored at regular freezer temperatures for up to two weeks. This update to the ultra-cold storage requirements may help with distribution.

The process of administration, according to Offit, will likely vary from locality to locality, depending on the proximity of “retail pharmacies” and “major hospital and university centers.” 

“For example, Philadelphia will probably handle it differently than a very rural, sparsely populated county in the center of the state,” he says.

Based on President Joe Biden's announcement, Phase 2 will begin by May 1. Then, it will be the general population’s turn to get vaccinated.

“For Phase 2, any American who is willing to be vaccinated will be eligible and likely be encouraged to take COVID-19 vaccine shots,” he says. 

The start of Phase 2 is also when Offit thinks local, state, and federal governments will begin to loosen some restrictions. But he cautions against thinking of the vaccine as a quick fix for the pandemic. Only once two-thirds of the population has been vaccinated, he says, will we be able to “really get on top of this virus.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Centers for Disease Control and Prevention. The Advisory Committee on Immunization Practices' interim recommendations for allocation COVID-19 vaccine—United States, December 2020. Updated December 31, 2020.

  2. Kaiser Family Foundation. The COVID-19 "vaccination line": an update on state prioritization plans. Updated January 11, 2021.

  3. Kaiser Family Foundation. State COVID-19 vaccine priority populations. Updated March 15, 2021.

  4. The White House. Fact sheet: President Biden to announce all Americans to be eligible for vaccinations by May 1, puts the nation on a path to get closer to normal by July 4. Updated March 11, 2021.

  5. Dooling K. Phased allocation of COVID-19 vaccines. Updated December 1, 2020.

  6. Moderna, Inc. Moderna announces primary efficacy analysis in phase 3 COVE study for its COVID-19 vaccine candidate and filing today with U.S. FDA for emergency use authorization. Updated November 30, 2020.

  7. Centers for Disease Control and Prevention. CDC’s COVID-19 Vaccine Rollout Recommendations. Updated February 19, 2021.

  8. Kaiser Family Foundation. COVID-19 has claimed the lives of 100,000 long-term care residents and staff. Updated November 25, 2020.

  9. The Harris Poll. Which of the following groups should receive priority when a COVID-19 vaccine is available?: Survey of 1,399 U.S. adults. Updated August 14-16, 2020.

  10. Food and Drug Administration. Coronavirus (COVID-19 update): FDA allows more flexible storage, transportation conditions for Pfizer-BioNTech COVID-19 vaccine. Updated February 25, 2021.

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