Since the pandemic began, ACIP has been holding special meetings to review U.S. data on COVID-19 and the vaccines in development to help prevent it. Before making recommendations, ACIP plans to review all available clinical trial information, including descriptions of

  • Who is receiving each candidate vaccine (age, race, ethnicity, underlying medical conditions)
  • How different groups respond to the vaccine
  • Side effects experienced

If the Food and Drug Administration (FDA) authorizes or approves a COVID-19 vaccine, ACIP will quickly hold a meeting to review all available data about that vaccine. From these data, ACIP will then vote on whether to recommend the vaccine and, if so, who should receive it. Included in ACIP’s recommendations will be guidance on who should receive COVID-19 vaccines if supply is limited. Recommendations must go to the director of CDC for approval before becoming official CDC policy.

Goals for vaccination if supply is limited

ACIP has set the following goals for deciding who to recommend COVID-19 vaccines for if supply is limited:

  • Decrease death and serious disease as much as possible
  • Preserve functioning of society
  • Reduce the extra burden the disease is having on people already facing disparities
  • Increase the chance for everyone to enjoy health and well-being

Ethical principles

ACIP is setting ethical principles to guide their decision-making process on who to recommend COVID-19 vaccines for if supply is limited. Early discussions have focused on the following five principles:

  • Maximize benefits and minimize harms — Respect and care for people using the best available data to promote public health and minimize death and serious disease.
  • Equity — Decrease health disparities and make sure everyone has a fair and just opportunity to be as healthy as possible.
  • Justice — Treat affected groups, populations, and communities fairly. Remove unfair, unjust, and avoidable barriers to good health and well-being.
  • Fairness — Give everyone in a priority group an equal chance to get COVID-19 vaccination.
  • Transparency — Make a decision that is clear, understandable, and open for review. Allow and seek public participation in the creation and review of the decision processes.

Groups considered for early vaccination if supply is limited

ACIP is considering four groups to possibly recommend COVID-19 vaccination for if supply is limited:

  • Healthcare personnel
  • Workers in essential and critical industries
  • People at high risk for severe COVID-19 disease due to underlying medical conditions
  • People 65 years and older

Healthcare personnel continue to be on the front line of the nation’s fight against this deadly pandemic. By providing critical care to those infected with the virus that causes COVID-19, many healthcare personnel have a high risk of being exposed to and getting sick with COVID-19. Healthcare personnel who get COVID-19 are also at risk of spreading the virus to patients seeking care for medical conditions that increase their risk for severe COVID-19 disease. Early vaccine access is critical to ensuring the health and safety of this essential workforce of approximately 20 million people, protecting not only them but also their patients and the broader health of our country. Learn who is included under the broad term “healthcare personnel.”

Workers in essential and critical industries are considered part of America’s critical infrastructure, as defined by the Cybersecurity & Infrastructure Security Agencyexternal icon. Current data show that many of these workers are at increased risk for COVID-19. Early vaccine access is critical not only to protect them but also to maintain the essential services they provide U.S. communities.

People with certain underlying medical conditions are at increased risk for severe COVID-19 disease, regardless of their age. Severe illness means that the person with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, or that they may even die. Early vaccine access is critical to ensuring the health and safety of this population that is disproportionately affected by COVID-19.

Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Early vaccine access is critical to help protect this population that is disproportionately affected by COVID-19.

Other frameworks

Input from the public and the following professional groups is informing ACIP’s discussions on who should receive COVID-19 vaccines if supply is limited:



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