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When can YOU get the vaccine? It depends on your health, occupation and where you live

With two Covid-19 vaccines approved for emergency use and politicians, health care workers and residents of long-term care facilities rolling up their sleeves, it’s a natural question: What about me and my loved ones?

A lot of factors play into the answer, and it depends on each person’s health, what they do for a living and where they live.

States will handle immunization campaigns differently, experts say. Some campaigns may be smoother than others, but if there is one piece of advice to keep in mind, it’s this: Keep taking measures to protect yourself and your family until you’re inoculated.

That means continuing to wear masks, socially distance, avoid large gatherings and regularly wash your hands.

“People just need to be patient,” said Claire Hannan, executive director of the Association of Immunization Managers. “They need to be vigilant and protect themselves from the virus.”

As for when Americans can lower their guards and get back to in-person socializing, “I would leave that to Dr. (Anthony) Fauci,” she said, referring to the nation’s top infectious disease expert and President-elect Joe Biden’s incoming chief medical adviser.

You have more questions; here are more answers:

Who is getting vaccinated first?

As has been widely reported, health care workers and residents of long-term care facilities are first in line, followed by adults ages 75 and older and frontline essential workers like first responders.

The next phase will be adults between 65 and 75, those between 16 and 64 with high-risk medical conditions and “other essential workers,” according to the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Who is an essential worker?

The ACIP defines front-line essential workers as anyone employed in “sectors essential to the functioning of society and are at substantially higher risk of exposure” to the coronavirus. Besides first responders, that includes those working in education, food, agriculture, manufacturing, corrections, the US Postal Service, public transit and grocery stores. There are roughly 30 million people in this category.

Jockeying for the vaccine

Other essential workers, according to ACIP, are people working in transportation, logistics, food service, construction, housing, finance, information technology, energy, sanitation, media, law, public safety and the water/wastewater industries. The category includes about 57 million Americans.

When will the general public get the vaccine?

This is a moving target that will be dictated by numerous variables. Dr. Vivek Murthy, Biden’s nominee for surgeon general, said he believes it may take until late spring to finish vaccinating high-risk populations if all goes according to plan. That means mid-summer may be a “realistic” timeline for the general public to begin vaccinations, he told NBC.

“If everything goes well, we may see a circumstance where, by late spring, people who are in lower risk categories can get this vaccine,” he said, “but that would really require everything to go exactly on schedule. I think it’s more realistic to assume that it may be closer to mid-summer, early fall when this vaccine makes its way to the general population.”

A recent ACIP chart indicated the general public may start getting the vaccine in about 20 weeks — which would put the target in May — which is “kind of in line with what I was thinking, too,” Hannan said.

Because states will handle rollouts differently, Hannan says it’s a good idea for people to monitor state health department websites for specifics. Some states are setting up “public-facing dashboards,” and she expects others will allow residents to register to sign up for updates, she said.

What factors drive the rollout phases?

The two main factors are supply and demand, essentially, how many people receive the vaccine and how much vaccine is available, Hannan said.

While Pfizer/BioNTech’s and Moderna’s vaccines have already received emergency use approval, Johnson & Johnson and AstraZeneca have vaccines in the works, which if approved, would increase supply, she said.

On the demand side, it will depend how many people in the first vaccination phases line up for the injections. If the numbers are high in those priority groups, it will take longer to move to the general public phase, Hannan said.

“So far, it does look like there is high demand, that health care workers are excited to get the vaccine. They’re lining up to get it. They’re posting pictures of themselves getting it,” she said.

Health professionals don’t want doses sitting around unused, so there will be disparities from state to state. For instance, she said, if priority groups in one state are more hesitant to get vaccinated, it may reach the general public faster because the state will move to the next phase to utilize the doses it has on hand.

What power do states have?

The vaccine providers have committed to following ACIP guidelines, but there is significant leeway, providing the states flexibility, Hannan said.

“States will give their own guidance, and just by virtue of where they send the vaccine, states are making decisions about who is getting it first,” she said.

ACIP provides “the compass that everyone is following,” she said, but states have discretion when it comes to matters like underlying conditions and essential workers. One state might choose, based on its circumstances, to prioritize the elderly or long-term care facilities over health care workers.

In the 2009 swine flu pandemic, young children were at especially high risk, so many states intensely focused on children and health care workers, while other regions saw rapid improvement in their numbers and were able to shift their focus to the general public sooner. Rhode Island was still administering vaccinations in schools while Texas was distributing vaccines to pharmacies, Hannan said.

“The categories are broad enough for states to be more focused or less focused on certain populations,” she said.

With doses limited, as they are now, observers aren’t seeing much variation from state to state, but it should be more apparent as the vaccine becomes more available.

Who is making decisions at the state level?

It will ultimately fall on state governors to make calls on who gets the vaccinations and when, Hannan said.

However, most states have advisory committees or tasks forces in their health and preparedness agencies that will provide recommendations to governors. State officials can also lean on ACIP guidance, and the CDC has a jurisdictional playbook, which the National Association of County and City Health Officials says outlines the “strategy for delivering and administering a COVID-19 vaccine as quickly and efficiently as possible.”

“It’s difficult for governors to stray too far,” Hannan said. “Hopefully, we won’t see it get political.”

What if people try to cut the line?

Concierge medical services in California have already reported wealthy residents are seeking to pay thousands to skip the queue for the Covid-19 vaccine. Gov. Gavin Newsom has vowed to monitor the situation and ensure ethical standards are maintained so “those with means, those with influence are not crowding out those that are most deserving of the vaccines.”

It’s a matter each state will have to handle individually, Hannan said, but in the grand scheme of a nationwide vaccination campaign, it isn’t the most troubling concern.

On one hand, it’s an indicator of high demand, which means more vaccine acceptance, she said. On the other hand, those administering the vaccine have enough to worry about without being burdened with checking everyone’s identification, occupation or medical history. It’s all a matter of balance, she said.

“We don’t want to be turning people away, and we don’t want vaccine sitting around,” she said. “States are going to have to address it when situations like this arise, rather than make people go through a lot of hoops. … I don’t think it’s a great thing, but I’d rather have that than people not wanting the vaccine.”

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