The Advisory Committee on Immunization Practices' Updated Interim Recommendation for Allocation of COVID-19 Vaccine

United States, December 2020

Kathleen Dooling, MD; Mona Marin, MD; Megan Wallace, DrPH; Nancy McClung, PhD; Mary Chamberland, MD; Grace M. Lee, MD; H. Keipp Talbot, MD; José R. Romero, MD; Beth P. Bell, MD; Sara E. Oliver, MD


Morbidity and Mortality Weekly Report. 2020;69(5152):1657-1660. 

In This Article

Abstract and Introduction


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