State COVID-19 Vaccine Distribution Plans, Priorities

With the chaotic and insufficient distribution of testing supplies and PPE still top of mind and a clear understanding that early vaccine demand will far exceed the supply, states months ago began to develop vaccine distribution plans to target high-priority populations while incorporating evolving federal recommendations.

As of October 2020, no 2 states had prioritized their populations in precisely the same way, according to an analysis by the National Academy for State Health Policy (NASHP). Most allocation plans incorporate CDC and other federal guidance and many states refine strategies based on interstate advisory boards.

How state distribution plans may vary

Number of phases. Number may vary, from 2 to 5. Most have 3 or 4 with some subcategorized further into A, B, and C.

Delineation of phases. As of early December, some states had only identified Phase 1 populations while waiting for additional federal or interstate guidance.

Priority group size. About 40% of states have reported number of individuals in each priority population; details could influence distribution plans. Mapping and other software will identify locations of priority populations.

Specific high-risk populations. Some states include racial/ethnic minority groups, tribal and rural populations within a specific phase. Others will recruit vaccine providers in underserved areas but do not list groups as targeted.

Nuance of priority populations. Delineation differs within phases, eg, some states group essential workers, or congregate care residents, in one phase. Others may prioritize congregate care residents aged ≥65 years vs those younger living in homeless shelters or prisons.

Despite variations, all 50 states and Washington, DC have prioritized healthcare workers, placing them in Phase 1 distribution. Below, flash cards define phases and priority populations.