Good morning. We hope you enjoyed yesterday’s special newsletter on the coronavirus vaccine supply chain. But that was just Part 1. Today we bring you Part 2, which focuses less on the physical materials and more on the humans.

Let’s set the mood with this passage from The Economist:

“Deliverance, when it arrives, will come in a small glass vial. First there will be a cool sensation on the upper arm as an alcohol wipe is rubbed across the skin. Then there will be a sharp prick from a needle. Twenty-one days later, the same again. As the nurse drops the used syringe into the bin with a clatter, it will be hard not to wonder how something so small can solve a problem so large.”

Reality check: There won't be enough Covid-19 vaccines for everyone for a while. Probably years. Thankfully, the CDC has some rules so distribution won't look like a run on the Hunger Games cornucopia.

Once a vaccine is approved by the FDA, the CDC's Advisory Committee on Immunization Practices will hold an emergency meeting within 48 hours to finalize recommendations around who gets the first shots. That guidance will be given at the national scale, which means state health officials will be left to figure out the nitty-gritty details of where the vials are going.

As we saw early in the pandemic with various lockdown measures, approaches by states can vary.
Who's first?
The U.S.' ~20 million healthcare workers, including doctors, nurses, and support staff, will likely be top priority. Three other groups are widely considered to be especially vulnerable to the coronavirus:

The elderly (about 50 million Americans ages 65+)
People with underlying conditions (80–100 million)
Essential workers (40–60 million)
That's a lot of millions, and definitely more than we'll have vaccines for at first. Even people who qualify for priority vaccination will contend with limited supply.

Some public health experts have also argued for early vaccinations for racial and ethnic minorities, who've experienced higher rates of coronavirus infection and death.

And the children? Pharmaceuticals are, for good reason, not tested on kids first, and it'll take longer to get a vaccine approved for the youths. Only a few companies, including Pfizer, have started pediatric trials.

Other factors to consider
#1: Different vaccines have different logistical challenges and health considerations, which could affect who gets what when. Some vaccines may be better suited for the elderly, people with heart conditions, or pregnant women. Single-dose vaccines and ones that don't require ultra-cold storage can reach rural communities more easily.

#2: Is the goal to limit spread or deaths? Before the swine flu pandemic, the strategy was to vaccinate the most vulnerable first. But in 2009, researchers published a study suggesting a focus on vaccinating the biggest spreaders—in the case of swine flu, children ages 5–19—to protect everyone else.

It helped, and now CDC guidance advises annual flu shots for kids six months and older.
#3: Not everyone will get a vaccine. In the last decade, the U.S. has never vaccinated more than half of adults for the flu, and vaccination rates for Black, Latinx, and high-risk adults trend lower.