• The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended Sunday that frontline essential workers and people 75 and older should be next in line for coronavirus vaccines.
  • Healthcare workers and residents of long-term care facilities have already started receiving their shots.
  • The US should have enough shots to complete these first two phases of vaccinations by sometime in February. 
  • The third round of shots should go to people ages 65 to 74, people ages 16 to 64 with high-risk medical conditions, and any other essential workers that haven't been vaccinated yet, the CDC recommended.
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People ages 75 and older and frontline essential workers should be next in line to receive coronavirus vaccines, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended at a Sunday meeting.

This second priority group constitutes around 49 million people, according to the CDC. The US is already beginning to vaccine its first priority group: roughly 21 million healthcare workers and three million residents of long-term care facilities.

The CDC's recommendations are based on two key goals: preventing disease transmission and mortality, and preserving the overall function of society.

Protecting elderly individuals from COVID-19 is critical to that first goal. People ages 75 and older represent one-quarter of COVID-19 hospitalizations and around 60% of COVID-19 deaths in the US — more than another age group, according to the CDC. 

Frontline essential workers, meanwhile, are both necessary to a functioning society and face an increased risk of exposure to the coronavirus due to the public-facing nature of their work.

Data from the May to July coronavirus outbreak in New York City suggests an overwhelming number of workers in public service agencies got infected: on average, 22% of their antibody tests came back positive. Among these workers, correctional staff had the highest percent positivity rate: nearly 40%.

The CDC classified frontline essential workers as first responders (firefighters and police officers) as well as workers in education (teachers, school support staff, and daycare workers), food and agriculture, manufacturing, corrections, US postal service, public transit, and grocery stores.

Once these individuals are vaccinated, the advisory committee recommended that the third round of shots go to people ages 65 to 74, people ages 16 to 64 with high-risk medical conditions, and any other essential workers who haven't been vaccinated yet.

COVID-19 vaccine, New York
Long Island Jewish Medical Center in New Hyde Park, New York, was the first hospital to roll out the COVID-19 vaccine in the US.
Mark Lennihan/Pool via REUTERS

These remaining essential workers would include those in transportation, food service, construction, finance, information technology and communication, energy, media, law, engineering, and water and waste management.

High-risk medical conditions, according to the CDC, include obesity or severe obesity, type 2 diabetes, chronic obstructive pulmonary disease (COPD), heart conditions, chronic kidney disease, cancer, an immunocompromised state from a solid organ transplant, sickle cell disease, pregnancy, or a history or current practice of smoking. 

In total, this third phase would include roughly 129 million people. 

But ultimately, it's up to each state to decide how to prioritize their vulnerable populations. 

"There will be difficult choices about who gets that vaccine first," Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC, said at Sunday's meeting. 

If doses are scarce, the advisory committee said, states may consider prioritizing vaccinations for frontline essential workers in areas with high transmission, who haven't had COVID-19 in the past 90 days, or who have an increased risk of severe illness based on their age or underlying medical problems.

States may also consider vaccinating residents of congregate living facilities — such as prisons, jails, and homeless shelters — at the same time as the facilities' staff members, the committee said. 

Vaccinating two priority groups by February 

The Food and Drug Administration has authorized two shots for emergency use in the US. Moderna's vaccine was authorized on Friday and could be administered as early as Monday. Pfizer's vaccine was authorized a week prior and is already being given out across the country.

Healthcare workers were the first to receive their shots on December 14. CVS and Walgreens started giving shots to residents of long-term care facilities on Friday.

A recent Kaiser Family Foundation report found that 45 states are following the CDC advisory group's recommendations, but a few are veering slightly off course. Nevada, New Hampshire, and Wyoming, for instance, are including law enforcement in their first round of vaccinations, while Massachusetts is including incarcerated people and those in homeless shelters.

Over the last week, around 2.8 million doses have been distributed and more than 556,000 doses have been administered in the US, according to the CDC.

Federal officials estimate 100 million people could get their full two-dose regimen before March. (Pfizer's shot requires two doses taken 21 days apart while Moderna's shot requires two doses taken 28 days apart.)

"There should be enough vaccine to vaccinate 20 million people in December, 30 million people in January, and 50 million people in February," Messonnier said Sunday.

That means the US should have enough shots to complete its first two rounds of vaccinations (phase 1a and 1b) in February. The third round of vaccinations (phase 1c) could also begin that same month:

Phase 1 and 2 rollout
Centers for Disease Control and Prevention

Members of the general public may start getting immunized by April, according to the CDC's timeline. By that point, the country could be vaccinating 10 million people per week.

Moncef Slaoui, who is spearheading the US vaccine effort, Operation Warp Speed, told the Washington Post that most Americans could be immunized by mid-year 2021.

But that timeline is optimistic, according to other experts. US Surgeon-General nominee Dr. Vivek Murthy estimated Sunday that the general population might not receive their shots until "midsummer or early fall."

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