How countries are dealing with the delicate matter of who to vaccinate first

COVID-19 vaccines should start becoming available in the Western world for the first time in a matter of days. So, who should be given early access?

Officials far and wide have been delving into the delicate process of deciding who will receive the initial, limited batches of vaccines as they thread together the complex supply chains necessary to deliver them.

In the UK, which became the first Western country to grant emergency-use authorization for a COVID-19 vaccine, nursing home residents and staff are technically first in line for doses expected to arrive next week. Germany may also prioritise the elderly (depending on whether doses prove to be too potent), Japan plans to issue coupons for its first doses designated for senior citizens, while Indonesia plans to prioritise workers as young as 18.

In Australia, the initial priority groups identified include Aboriginal and Torres Strait Islander people. And a vote in the US on Tuesday means a mix of health care workers and nursing home residents will be prioritised for that country’s first supply – which might become available later this month.

People in low-income countries that were not privy to the billions of doses that had been acquired by last month might find themselves at the back of the global line. Moderna may charge as much as $37 for a single dose under a “cheaper” pricing program, for example, though AstraZeneca and Oxford University have committed to selling doses for as little as $2. Still, experts think many residents of poorer countries might have to wait until as late as 2024 for vaccinations.

One international initiative, the COVAX Facility, aims to pool resources among wealthy and poor nations to ensure more equitable vaccine access, and has secured hundreds of millions of doses. The success of COVAX is not certain, however, and countries like the US and Russia have opted to not participate (the US may yet under a new administration).

After receiving the first available doses, many people will still have to wait weeks before they’re actually vaccinated. Moderna’s vaccine requires a four-week gap between a first and second required dose, for example.

Initial vaccinations will cover relatively small parts of each country’s population. While the UK has ordered enough doses for about a third of its residents, only 800,000 doses are expected to arrive in its first batch next week. Other countries that more successfully managed the outbreak, such as South Korea, have taken a more deliberate approach to securing initial supplies.

One problem that may arise as doses become available is a reluctance to take them. Less than two-thirds of health care workers in the US polled recently said they’d get a COVID-19 vaccine. Surveys conducted among the broader US population showed that only half would agree to a free vaccination as of September, though that has since increased to nearly 60%.

Another nagging question: it remains unknown whether those vaccinated will still be able to pass the virus on to others, even if they’ve protected themselves from getting sick.

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