a syringe in front of an American flag

The US Centers for Disease Control and Prevention (CDC) has met to decide how to distribute a Covid-19 vaccine as several drugs inch closer to approval.

The Advisory Committee on Immunization Practices meeting heard that some 40m Covid-19 vaccine doses will be available by the end of December. The panel said healthcare workers and care home residents will be first in line to get the jab.

There are two US vaccines, made by Moderna and Pfizer, that are both seeking emergency approval.

The Food and Drug Administration (FDA) plans to meet on 10 December to discuss approval for the Pfizer vaccine. They will meet again on 17 December to discuss Moderna’s request.

On Monday, Vice-President Mike Pence told US governors in a conference call that rollout of the vaccine could begin “as soon as the week of December 14”.

The guidelines come as coronavirus cases continue to balloon across the US, with an average of over 150,000 new cases reported per day. The US has recorded a total of 13.6 million cases and some 270,000 deaths, according to Johns Hopkins University.

When will vaccines be ready?

Both Moderna and Pfizer are seeking Emergency Use Authorization for their vaccines. The authorisation allows a drug to be used as a treatment while studies are still being carried out to determine safety and effectiveness. Critics say the process is less rigorous and more likely to lead to health complications.

Top disease researcher Anthony Fauci has dismissed those concerns saying the emergency process “does not at all compromise safety, nor does it compromise scientific integrity”.

FDA Commissioner Stephen Hahn was summoned to the White House on Tuesday to be questioned on why approval was not moving more quickly.

“Let me be clear – our career scientists have to make the decision and they will take the time that’s needed to make the right call on this important decision,” Mr Hahn said in a statement.

Health Secretary Alex Azar said on Monday that both drugs will be ready to ship within 24 hours of the FDA’s approval.

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“So, we could be seeing both of these vaccines out and getting into people’s arms before Christmas,” he told CBS.

According to notes from Mr Pence’s conference call on Monday, Pfizer plans to have 6.4 million doses ready for delivery by 19 December. Because two shots are required per person, that is enough for three million people, out of a total US population of 330 million.

By the following week, both Pfizer and Moderna are expected to have produced enough vaccines for another 10 million people. By the end of the month, both companies are anticipated to have produced enough vaccine for 30 million people.

Who will get the vaccine first?

Federal officials at the CDC agree that the nation’s 21 million healthcare workers should be prioritised first, as well the three million elderly Americans living in long-term care homes.

But there is less consensus on how states should distribute it to other groups.

The nation’s approximately 87 million essential workers are expected to be next in line for the jab, but it will be up to states to decide which industries to prioritise.

A sign says no vaccine is yet available at a pharmacy in California

Moncef Slaoui, who leads the federal government’s Operation Warp Speed vaccine distribution programme, said he does not “expect the states to make uniform decisions”.

“Some may prefer long-term care facilities or the elderly, while others may prioritise their health care workers. It would be wrong to immunise 18-year-olds first. I hope no one does that. But otherwise it’s shades of grey.”

Officials say vaccinations for groups that are not at a high risk are expected to take place in the spring of 2021.

There are also ongoing concerns regarding how many Americans are willing to get vaccinated. A recent Gallup poll found that 58% of Americans say they would be willing to get the jab, up from a low of 50% in September.

It also remains to be seen how racial minorities – who are at a higher risk of catching the virus and dying from it – will be prioritised.

Last month, New York’s governor decried the federal government’s immunisation plan as “discriminatory,” saying that distribution infrastructure such as pharmacies and hospitals are less prevalent in black and Latino communities.

What have states said?

On Monday, Kentucky’s governor said the state’s first vaccine shipment would mostly go to the elderly, with a smaller amount being given to hospital workers.

Colorado has said they would prioritise ski industry workers living in shared housing. Other states may choose to prioritise meat industry workers, who have been hit hard by the virus.

California Governor Gavin Newsom has said priority will be given to the state’s 2.4 million healthcare workers, who are being divided into smaller sub-groups in case of early shortages.

“Mass vaccination is unlikely to occur anytime soon,” he said. California has already appointed some 65 different labour and advocacy organisations to help ensure an equitable distribution of the vaccine.

What will the vaccines cost?

In July, the US Department of Health and Human Services announced a $1.95bn (£1.45bn) deal to secure 100 million vaccine doses from Pfizer. The agreement also allows the US government to purchase an additional 500 million doses.

Moderna received nearly $1bn from the US government for coronavirus research. They are set to receive an additional $1.5bn for 100 million doses, according to a deal signed in August.

Billions of dollars have also been promised to other drug companies in the event that they are able to bring additional vaccines to market.

The CDC says that vaccines purchased with taxpayer money will free, but providers may still charge for administering the jab. That fee may be reimbursed by health insurance companies or the Medicaid and Medicare programmes – social safety nets for low income and elderly Americans.

States are also racing to acquire ultra-cold refrigerators that are capable of storing the Pfizer vaccine, which much be kept at temperatures of minus 70C (minus 94 F).

Each refrigerator costs tens of thousands of dollars, and have been harder to find in recent days as hospitals race to purchase them.

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