Governments around the world weigh thorny question: Who gets the vaccine first?

While federal and state officials agree that the nation’s 21 million health care workers should be first in line for the vaccine, there is no consensus about how to balance the needs of other high-risk groups. Azar said this week states will have the “final say” in prioritizing Covid vaccinations, and that the shots will be apportioned according to the size of adult populations. Siding with ACIP, California Gov. Gavin Newsom pledged that hard-hit “Black and brown communities disproportionately are benefited” in California’s prioritization plan.

Moncef Slaoui, the former GlaxoSmithKline executive who leads Operation Warp Speed, said there are no easy choices.

“I don’t expect the states to make uniform decisions,” he told POLITICO. “Some may prefer long-term care facilities or the elderly, while others may prioritize their health care workers. It would be wrong to immunize 18-year-olds first. I hope no one does that. But otherwise it’s shades of gray.”


Canada is taking into account public opinion preferences in its strategy, which suggests “Canadians prioritize those with underlying medical conditions and the elderly,” and also treating “household contacts of those at high-risk of severe illness and death” as potential priorities. The defense department is buying freezers to “store and transport” Covid-19 vaccines for its “military population.”

European Union

Xavier Bettel, prime minister of Luxembourg, said in an interview that the EU has a difficult starting position when it comes to Covid-19 vaccinations: “There is not one country where over 60 percent of people want to get vaccinated.”

However, a tug-of-war between Brussels-based EU institutions and national governments over how to source and deliver vaccines appears to have ended happily: European Commission President Ursula von der Leyen confirmed this week that the EU has secured vaccines for 430 million people — enough for virtually every EU resident. It would have created a “nightmare” if the EU failed to coordinate distribution, Bettel said.

Among a series of priority measures, the European Centre for Disease Prevention and Control said it will deploy the vaccine to “control active outbreaks.”

Germany’s Standing Committee on Vaccination recommends that prioritization be guided by “urgency of preventive health protection,” aiming to reduce cases most likely to lead to hospitalization or death, and to ensure “maintenance of essential state functions and public life,” which includes police, firefighters and teachers, in addition to healthcare workers.

United Kingdom

The U.K.’s Joint Committee on Vaccination and Immunisation has an 11-step order of priority. After healthcare workers, the priorities are older adults in care homes, then older Britons, starting with the eldest and descending in 5-year age brackets.


Japan’s top priority is older citizens with chronic conditions. Citizens will be issued coupons indicating their order of priority, Japan’s Health, Labor and Welfare Ministry said.


Class and geographic divides have produced significant variations in India’s death rates. 80-year-olds in some states are surviving more often than 60-year-olds in others, University of Chicago Professor Anup Malani writes on behalf of The Indian Covid Alliance. The government’s response: set a lower age threshold than most Western countries — 50 years — for priority access.

The task is massive. There are 260 million Indians aged 50 or older, and around 20 million frontline workers. The government is concerned about confusion over who is entitled to priority access. A National Expert Group on Vaccine Administration has worked with state governments to create a new “digital platform for vaccine administration and distribution” the group said in a statement.

South Korea and Taiwan

As standout performers in controlling Covid-19, the two East Asian nations also share an unusual vaccine deployment approach: They’re relatively relaxed about it. As members of the COVAX facility — which is pooling the resources of 186 governments to accelerate vaccine development and distribution — both governments are prioritizing buying the vaccine at the right price, rather than as soon as possible. Each plans to buy enough vaccines for only around 60 percent of their populations.

While Taiwan has a history of high demand for vaccines — the Taiwan Centers for Disease Control reported an average 98 vaccination rate in 2019 — the government is not afraid to ration vaccines. In November, the government banned people aged 50 to 64 from receiving state-funded influenza vaccines, in order to prioritize more vulnerable groups.