Vaccine Distribution

The COVID-19 US State Policy Database (CUSP) documents the phases and characteristics of each state’s COVID-19 vaccine allocation plan. With a limited number of vaccines available, vaccine priorities shape who gets the COVID-19 vaccine first and who gets the vaccine months down the road. These policies also shape racial and ethnic disparities in continued COVID-19 cases and deaths.

The Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommended that health care personnel and residents of long-term care facilities receive the first available doses of vaccines, followed by adults ages 75 and older and frontline essential workers in grocery stores and restaurants, who have had high rates of COVID throughout the pandemic. Nearly all states followed ACIP recommendations to prioritize long-term care facilities. Most states initially followed ACIP recommendations and put essential workers near the front of the line for vaccination; but after the federal government recommended instead using age thresholds, many states shifted their allocation plans to allow adults ages 65 to 74 to receive a COVID-19 vaccine before essential workers.

Although people who are incarcerated live in congregate settings and face highly elevated rates of COVID-19 cases and deaths, ACIP did not include guidelines for people who are incarcerated in their vaccine allocation plans. As CUSP documents, most states did not prioritize people who are incarcerated for vaccination.

While CUSP documents vaccine priorities, it is important to keep in mind that other aspects of implementation also affect vaccination speed and equity. As a New York Times editorial details, providing opportunities for people to sign up for vaccine appointments via phone as well as Internet is important for reaching communities with lower Internet access. Providing phone lines and websites in multiple languages is also important. As Drs. Miller, Weintrab, and Gawande describe, removing bureaucratic paperwork requirements and relying on honor codes to vaccination, such as proof of eligibility, can streamline the process and help to reach minoritized communities.


Drs. Persad, Peek, and Emanuel outlined ethical considerations for vaccine priorities, including prioritizing direct benefits in preventing years of life lost and indirect benefits such as caring for dependents or providing essential social services like education. Dr. David Grabowski documents that prioritizing nursing homes for vaccinations has been associated with large declines in COVID-19 cases and deaths based on CDC data. On the other hand, vaccine policies deprioritizing essential workers, who are more likely to be Black and Latinx, may have exacerbated disparities. Kaiser Health News reports that Black and Latinx people have been less likely to be vaccinated than White people. Doctors Uché and Oni Blackstock outlined steps to improve equitable vaccine rollout.


In states that prioritize essential workers, it makes a big difference for people who face high levels of exposure to COVID-19 through their work every day. Pastry Chef Fanny Gerson described that she “just started bawling” after being on edge as part of a high risk family engaged in in-person work during the pandemic.

A grocery store worker described, “It’s rough to get up the courage, which is what it takes to walk in that door each day.” CUSP documents that half of states have deprioritized grocery workers after ACIP’s recommendation of phase 1b.

Successful community-based efforts to distribute COVID-19 vaccines in Latinx and Black communities hard hit by COVID-19 in Philadelphia, Pennsylvania, and Central Falls, Rhode Island, demonstrate that it is feasible to prioritize communities of color hardest hit by COVID-19 for vaccinations.

CUSP data can inform prioritization for several groups. Inside Higher Ed reporter Elizabeth Redden used CUSP data to highlight how states are choosing to prioritize K-12 educators and higher education employees.