2021 BQ Journal Vol 42 - 22

Morbidity and Mortality Weekly Report
Early Release / Vol. 69

December 22, 2020

The Advisory Committee on Immunization Practices'
Updated Interim Recommendation for Allocation of COVID-19 Vaccine -
United States, December 2020
Kathleen Dooling, MD1; Mona Marin, MD1; Megan Wallace, DrPH1,2; Nancy McClung, PhD1; Mary Chamberland, MD1,3; Grace M. Lee, MD4;
H. Keipp Talbot, MD5; José R. Romero, MD6; Beth P. Bell, MD7; Sara E. Oliver, MD1

The first vaccines for prevention of coronavirus disease 2019
(COVID-19) in the United States were authorized for emergency use by the Food and Drug Administration (FDA) (1) and
recommended by the Advisory Committee on Immunization
Practices (ACIP) in December 2020.* However, demand for
COVID-19 vaccines is expected to exceed supply during the
first months of the national COVID-19 vaccination program.
ACIP advises CDC on population groups and circumstances
for vaccine use.† On December 1, ACIP recommended that
1) health care personnel§ and 2) residents of long-term care
facilities¶ be offered COVID-19 vaccination first, in Phase 1a
of the vaccination program (2). On December 20, 2020, ACIP
recommended that in Phase 1b, vaccine should be offered
to persons aged ≥75 years and frontline essential workers
(non-health care workers), and that in Phase 1c, persons aged
65-74 years, persons aged 16-64 years with high-risk medical conditions, and essential workers not recommended for
vaccination in Phase 1b should be offered vaccine.** These
recommendations for phased allocation provide guidance for
federal, state, and local jurisdictions while vaccine supply is
limited. In its deliberations, ACIP considered scientific evidence regarding COVID-19 epidemiology, ethical principles,
and vaccination program implementation considerations.
ACIP's recommendations for COVID-19 vaccine allocation are
interim and might be updated based on changes in conditions
of FDA Emergency Use Authorization, FDA authorization

for new COVID-19 vaccines, changes in vaccine supply, or
changes in COVID-19 epidemiology.
Since June 2020, ACIP has convened 10 public meetings to
review evidence-based information pertaining to COVID-19
vaccines, including initial allocation of COVID-19 vaccine
supplies.†† To inform policy options for ACIP, the COVID-19
Vaccines Work Group, comprising experts in infectious diseases, vaccinology, vaccine safety, public health, and ethics,
held 28 meetings to review data regarding vaccine candidates,
COVID-19 surveillance, modeling of allocation scenarios, and
vaccination program implementation issues. The Work Group
also considered the relevant scientific literature, including
ethical principles related to vaccine allocation in the setting of
limited supply. Following ACIP's interim recommendation for
vaccine allocation in Phase 1a (2), the Work Group proposed
vaccine allocation for Phases 1b and 1c. A description of the
population groups in these phases, supporting scientific data,
consideration of ethical principles, and considerations for vaccination program implementation are presented in this report,
and supporting evidence is available at https://www.cdc.gov/
vaccines/hcp/acip-recs/vacc-specific/covid-19/evidence-tablephase-1b-1c.html.

Phase 1b
Approximately 49 million persons, including frontline
essential workers (non-health care workers) and persons aged
≥75 years are recommended to receive vaccine in Phase 1b of
the COVID-19 vaccination program (Table). Essential workers
perform duties across critical infrastructure sectors and maintain the services and functions that U.S. residents depend on

* https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html.
https://www.cdc.gov/vaccines/acip/committee/acip-charter.pdf.
https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/
appendix/terminology.html.
¶ https://www.cdc.gov/longtermcare/index.html.
** On December 20, 2020, ACIP voted 13 to 1 in favor of the Phase 1b and 1c
allocation recommendations.
†
§

††

https://www.cdc.gov/vaccines/acip/meetings/index.html.

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

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2021 BQ Journal Vol 42

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