The United States is set to start the distribution of a coronavirus vaccine in December, prompting federal health agencies and public health officials to determine who should receive the first doses of the vaccine.

Pfizer and its German collaborator BioNTech and American biotechnology company Moderna are expected to receive emergency use authorization from the U.S. Food and Drug Administration in the coming weeks. The vaccines took eight months to develop—the quickest a vaccine has ever been made in the history of medicine. 

“These vaccines have the potential to be real game changers as we go into 2021,” former FDA commissioner Scoot Gottlieb said. “You can effectively end the U.S epidemic.”

However, the government would likely face difficulties in physically distributing the vaccine and inoculating more than 330 million people in the country, CNBC reports. 

Who will get the first doses of the vaccine?

After the FDA grants emergency use authorization, a panel of experts from the Advisory Committee on Immunization Practices would release its recommendations on who should get the coronavirus vaccine first. 

The panel, which is expected to meet on Tuesday, would likely advise the nation’s 21 million health care workers and support personnel, along with three million nursing home residents, to be first in line. Elderly people living in long-term care facilities and people with pre-existing medical conditions could also be prioritized. 

Pfizer and Moderna are unlikely to develop enough vaccine to inoculate more than 22.5 million Americans by January, which means state governments should decide which health care worker receives the first dose, CBS News reported. 

Public health officials may prioritize critical care doctors and nurses and hospital staff members who are at high risk of an infection. However, they may also choose to vaccinate older health care workers first.

Who may get the COVID-19 vaccine next?

The ACIP hinted last week that it could recommend the country’s 87 million essential workers to be next in line for the coronavirus vaccine. Workers included in the list would be people who work in food and agriculture, manufacturing, law enforcement, and emergency response. 

The majority of workers in these sectors are people from the Black and Hispanic communities, which have been disproportionately impacted by the coronavirus pandemic. 

When could prisoners receive the coronavirus vaccine?

Prisoners live in crowded conditions where social distancing is virtually impossible. Many inmates also suffer from pre-existing conditions—including asthma, diabetes, and heart disease—making them vulnerable to a severe case of the novel coronavirus. 

The ACIP is expected to prioritize correctional officers and other employees who work in the country’s federal prison system. However, another prison outbreak could result in a massive number of infections and deaths among inmates. 

Since the pandemic began in March, more than 18,000 inmates have been diagnosed with the COVID-19 pandemic. Over 141 inmates have died, according to the Associated Press

Nearly 25% of all coronavirus cases involving inmates were reported just the last month. The number of infections is also rising in state prisons across the nation. 

Several groups, including the American Medical Association, are calling on the CDC to consider prioritizing inmates and employees at federal prisons and detention centers. The organization cited the risks that accompany people in confinement and the strain a potential outbreak could cause community hospitals, the New York Times reported.

“We aren’t saying that prisoners should be treated any better than anybody else, but they shouldn’t be treated any worse than anybody else who is forced to live in a congregate setting,” Dr. Eric Toner from the Johns Hopkins Center for Health Security said.

“Prisons are incubators of infectious disease. It’s a fundamental tenet of public health to try and stop epidemics at their source,” he added.