THE VACCINES are coming, and the prospect of several effective inoculations to combat the coronavirus pandemic is a remarkable scientific achievement. But even in the best of conditions, it will take time to overcome manufacturing and logistics hurdles, and to distribute hundreds of millions of shots equitably. Fasten your seat belts, and be patient.

The federal government’s Operation Warp Speed has signed contracts with the vaccine makers, including up to $1.95 billion to Pfizer for 100 million doses, up to $1.5 billion to Moderna for 100 million doses and others. Once the vaccines have been given an Emergency Use Authorization by the Food and Drug Administration and are manufactured, the federal government will allocate doses state-by-state based on population.

Supplies will be limited at first. A “framework” for how they should be distributed has been published by the National Academies of Sciences, Engineering and Medicine. It envisions a phased approach, to begin with a Phase 1 “jumpstart” group: high-risk health workers and first responders. After them, also in Phase 1, will come people of all ages with comorbid and underlying conditions that “put them at significantly higher risk,” as well as older adults living in congregate or crowded settings. When more supplies become available, Phase 2 would inoculate K-12 teachers, school staff and child-care workers; “critical workers in high-risk settings”; people with underlying conditions that put them at “moderately” higher risk; homeless people in shelters and shelter staff; staff and inmates in prisons; and all older adults.

When large supplies become available, Phase 3 would cover young children, as well as workers important to “the functioning of society” and those at increased risk of exposure who have not yet been covered. In Phase 4, everyone else. There are other recent proposals, too, including from the Centers for Disease Control and Prevention, Johns Hopkins University and the World Health Organization. Also, the government has arranged with pharmacies to help with distribution once supplies become more plentiful.

After FDA approval, the CDC’s Advisory Committee on Immunization Practices will weigh in with priorities in recommendations to the CDC director, Robert Redfield. If he approves, CDC recommendations then go to the states and territories, which carry out vaccination campaigns through public health departments. While most jurisdictions will probably hew broadly to CDC recommended priorities, they have leeway in how they define the categories of need, such as what comprises “critical workers.” Should a trucker whose job requires going into the community get priority over an older person who does not have to? The advisory committee has said the allocation choices must factor in ethical issues, including reduction of health disparities in the burden of covid disease and death, and removing “unfair, unjust, and avoidable barriers” to vaccination.

The promise of vaccines will be realized only if they are actually given. Polls show vaccine hesitancy remains a serious problem. Governments at all levels must be especially careful to build public trust in the shots and in the process, avoiding missteps that could fuel corrosive misinformation.

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