Who will get the first COVID vaccines? States race to decide

WASHINGTON — As the first COVID-19 vaccines move toward federal approval, states are racing to finalize plans for who will get the first doses and how they will be distributed — critical decisions that have taken on new urgency as drugmakers prepare to ship vaccines in just a few weeks.

State and federal health officials have largely agreed that front-line healthcare workers who have direct contact with COVID-19 patients should be vaccinated first, a vital step as infections soar this fall, filling hospitals across the country.

There is also broad consensus that nu rsing home residents and patients at other longterm care facilities should be targeted in the initial immunization push. The virus has proved to be particularly deadly in these populations.

That means most Americans shouldn' t expect to get a vaccine at t heir doctor's office or pharmacy f or many months.

Starting off with a targeted immunization campaign also puts off for now knotty qu estions about which people deserve to get assistance next, how minority and low-income communities hit hardest by the virus can be reached, and how the wealthy and well- connected can be prevented from jumping the line.

The stakes are high, said Thomas J. Bollyky, who directs the global health program at the Council on Foreign Relations.

“If we are going to reach the levels of vaccination that we need to control the pandemic, which will be challenging, we have to sustain the public's confidence ,” he said. “If we don't have a fair allocation of vaccines, that could undermine the whole campaign in a way that would do lasting damage.”

State health officials voice cautious optimism that they'll be prepared to distribute the first vaccines when they begin arriving next month.

“We've been working very hard to be ready in December,” said Dr. Mark Ghaly, California's health and human services secretary. “There are a lot of moving parts ... but we feel like we're on target.”

G ha ly and others noted that state and local health officials have considerable experience distributing vaccines, which is done every year ahead of the annual flu season.

“A lot of health departments have learned a lot of hard lessons over the years ,” said Dr. Cameron Kaiser, who directs public health in Riverside County, California, and serves on the board of the National Association of County and City Health Officials.

Nevertheless, the vaccination effort is being shadowed by the nation's struggles to stand up effective COVID-19 testing and the persistent inability of the federal government to get hospitals and other health care providers the protective equipment they need for their workers.

“I'm terrified that we're going to see a repeat of the disasters we saw with testing,” said Trish Riley, head of the nonpartisan National Academy for State Health Policy, who has worked for decades with state health officials around the country.

Also missing, according to many state and local health officials, is money to fund a massive vaccination campaign.

To date, the federal government has provided only about $200 million to state and local agencies, f ar short of the $ 6 billion that the U.S. Centers for Disease Control and Prevention has acknowledged will be necessary for a robust vaccination campaign.