When do I get my first dose of a COVID vaccine?


Q: Ok, you convinced me, the vaccine news is good. Yay! But: When do I get my first dose!? Will I be prioritized if vaccine supply is limited?

A: Vaccine supply will be limited at first to high-priority groups. The rest of us should be getting vaccine “in arm” starting in the spring and extending through the summer.

Pfizer filed paperwork with the FDA on Friday for Emergency Use Authorization for its mRNA vaccine. An FDA independent advisory committee known as VRBPAC will meet on December 10 to review the application. Once VRBPAC OKs it, the FDA is likely to finalize authorization within a few days (possibly even the next day), giving the green light for distribution.

In other words: People could be getting the vaccine as soon as December 11. Wow! How is that possible? One of the unique features of Operation Warp Speed was the commitment from participating biotech companies to manufacture and “preposition” vaccine doses prior to approval or authorization. Prepositioning means that vaccine doses should be sitting in freezers around the country awaiting that FDA green light.

So should you mark your calendar for a vaccine appointment on December 14? Only if you are in a “first in line” priority group. But who is first in line? In October, a committee from the National Academies of Sciences, Engineering and Medicine (NASEM) recommended a framework for “equitable allocation” of the vaccine, shown in the figure below, link to full report also below.

No big surprises here: the NASEM framework put high-risk health care workers and first respondents in Phase 1a, with Phase 1b covering people (of any age) with co-morbid or underlying conditions that put them at much higher risk of death or severe illness if they contract COVID-19. Older adults in congregate settings (like nursing homes) are also in Phase 1b.

Phase 2 in the NASEM framework includes K12 teachers (yay!!), critical workers in high-risk settings and industries essential to our functioning, and people in homeless shelters, group homes, prisons, jails, and detentions centers. People with medical conditions that put them at moderately higher risk and all other older adults are also included in Phase 2.

You’ve probably noticed that these first 2 phases already include a lot of people! The NASEM report estimates Phases 1 + 2 are about 15% of the total US population, or 50 million people. Because the Pfizer and Moderna vaccines both require 2 doses, that means 100 million doses would be needed to vaccinate everyone in Phase 1 and Phase 2.

After that, Phase 3 includes young adults, children, and workers in essential industries not covered in Phase 2. And Phase 4 is….everyone else!

It’s important to note that the timeline for when you and your family get vaccinated depends on many unknown factors at this point:

1. First, the NASEM allocation framework is only a recommendation. On Monday, November 23rd, the CDC’s Advisory Committee on Immunization Practices or ACIP will meet to determine their own framework (see link below, you can watch the meeting live!). ACIP may follow the NASEM framework closely or may make changes.

2. The ACIP allocation framework is ultimately also a recommendation to the 64 US jurisdictions (all states and territories plus some large cities) that handle vaccine distribution and delivery. Each jurisdiction has already drafted a COVID-19 vaccine distribution “playbook” which includes their own take on allocation. You can read the draft plan for your jurisdiction at the link below.

3. Vaccine supply will also be determined by how quickly doses can be manufactured and distributed to vaccine providers. You may have heard that the Pfizer vaccine has to be stored at -70 degrees Celsius (known as an “ultra low temperature” or ULT cold chain). Because ULT freezers are in short supply (large health systems have them, but your corner pharmacy doesn’t), it may be some time before locations like retail pharmacies, independent medical offices, public health clinics, and community-based organizations can give vaccines.

Bottom line: Unless you’re in a high-priority group, plan for your first dose to be available in late spring or early summer. The end is truly in sight, folks! Until then, #maskup, #staySMART, stay safe!


National Academies allocation framework
(Full disclosure: Nerdy Girl Alison Buttenheim served on the committee.)

CDC ACIP Meeting 11/23/20, 12pm EDT

Vaccine jurisdiction operational “playbook” drafts

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