A look at Phase 1 of the Pfizer vaccine distribution. 


On Dec. 11, the FDA issued an emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine. Four days later, on Dec. 15, the first shots were given to healthcare workers in New York. Vaccines will likely be available for residents of nursing homes this week. 

The two communities are among the CDC’s top priority groups for Phase 1a of the American vaccination campaign. The CDC’s recommendation was based on three objectives: decreasing death and disease as much as possible, preserving the functioning of society and reducing the negative effects that COVID-19 is having on people already facing disparities. 

With coronavirus vaccination campaigns now underway in the U.S. and others beginning in countries around the world, Americans are waiting in anticipation for the subsequent phases of the American vaccine distribution to begin. The approaching campaign has come with political, moral and social justice concerns, asking citizens and top officials the same difficult question: who is next in line?

According to Dr. Guliz Erdem, a pediatric infectious disease specialist at Nationwide Children’s Hospital, the answer to that question revolves around three primary populations: the high-risk population, healthcare providers and young adults. 

You want to be equitable when you make those decisions, and I feel fortunate that I don’t belong to any committee that has to have any decisions, but those are based on who’s at risk,” Erdem said. “I’m not old enough or I don’t have any underlying illness to put me at the high-risk group, but yet if I do get sick, who’s going to cover for me? And that’s more important if I were to be a paramedic or a surgeon, or emergency room or the intensive care physician.”

Erdem added that reducing the number of people infected was also incumbent upon the vaccination of groups with high transmission rates. For example, high school students. 

“Younger adults or older teens are more likely to transmit than some younger children. If you have to stratify the kids in terms of who should go and get the vaccine first, probably the high school kids should take the priority,” Erdem said. 

Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, echoed Erdem’s thoughts. Instead of high school students, Gottlieb examined transmission by essential workers. 

“If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” Gottlieb told the New York Times. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”

In addition to transmissibility and fatality, public health officials are also tasked with considering the disparate effects of COVID-19 on communities of color and the possible social and ethical ramifications. 

The patients we do see are from certain ethnic backgrounds. African-Americans, and the Latinx or Spanish backgrounds, and they do seem to be affected more than the white populations,” Erdem said. 

Dr. Peter Szilagyi, an advisory committee member and pediatrics professor at the University of California, Los Angeles, told the New York Times that “the issue of ethics is very significant, very important for this country, and clearly favors the essential worker group because of the high proportion of minority, low-income and low-education workers among essential workers.” However, Szilagyi’s views are not shared by all in the public health industry, with popular opinion leaning towards vaccinating the elderly and healthcare workers first, not all essential workers. 

Part of the reason for the divide is due to the word itself: essential. The CDC’s definition of “essential” includes 70% of the American workforce. There are approximately 30 million frontline essential workers and another 57 million essential personnel in other areas, such as transportation energy. With limited supplies, experts argue that the “essential” definition should be narrower. 

As of Dec. 20, Phase 1b did distinguish between various tiers of essential workers and high-risk populations. According to a CDC release, the Advisory Committee on Immunization Practices (ACIP) voted to prioritize frontline essential workers and persons over 75. Phase 1c will widen that range to include persons over the age of 64, other essential workers and the high-risk population between the ages of 16 and 64. 

The next step in the authorization process for Phase 1 requires final approval from the CDC. Once the CDC has approved the plan, the distribution is up to the state governments. Many of the final decisions and logistics are in the hands of the state officials. 

“How are you going to hold a vaccine clinic? Who is going to be responsible giving those vaccines? How frequently? How are you going to sign up? It’s really tricky,” Erdem said. “The worst [part] is, we still don’t know how it’s going to work.” 

Each state has different plans for the vaccine distribution. Ohio will divide the Pfizer shipments into smaller batches to be distributed to local health staff. Priority will be given to shipments based on county population and infection rates. Some states’ plans specifically mention focusing on minority groups in the distribution to combat disproportionate rates of infection. 

With many different plans and groups to consider, there are concerns that some states will distribute vaccines unequally and unfairly. 

“I do think that there will be some fairness, but is it as fair as what we hope to be? Perhaps not, because you’re giving almost all of the initiative to the state system, so there’s not a federal regulatory body,” Erdem said. However, she believes that states will act with an abundance of caution and fairness. 

Whoever you give the vaccine, it’s going to work out,” Erdem said. “There’s no question about that.”