How will you be told when it's your turn for a COVID-19 vaccine? It's complicated.
Do you receive a text from your doctor? Are you going to read about it online? Or do you need to go to the Centers for Disease Control and Prevention website to see when it is your turn?
Because COVID-19 vaccines are only being introduced to limited groups of people in the United States, according to public health and policy experts and state vaccination schedules, it's not as clear how people learn they are eligible to receive their shots while that is Offer remains limited.
"I think it's going to be a little cloudy," said Katie Greene, a Duke Policy officer at the Duke-Margolis Center for Health Policy.
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"I wouldn't be surprised if thousands of people were excluded because of the information gap," added Tinglong Dai, a professor at Johns Hopkins Carey Business School who studies health care operations management and business analytics.
Vaccine adoption has largely been left to the states, and with an "isolated and decentralized health system" in the US, as Dai put it, people may not know when they are eligible to get their vaccine. And they may need to proactively find out where to get one and show that they meet the criteria for their turn next.
Phase 1a of the vaccine rollout prioritizes healthcare workers and residents of long-term care facilities and is easy to reach because they are in different locations, Greene said.
The next phase should prioritize people aged 75 and over and key frontline workers, as recommended by the CDC's Advisory Committee on Immunization Practices. Then, in phase 1c, people 65 to 74 and people 16 to 64 with a high risk of illness and other important employees are included.
"These are groups that are a lot harder to reach," Greene said.
Dai believes there will be confusion and inefficiency as distribution continues into late winter and early spring when supply continues to grow and more but not all people are eligible for a vaccine.
"It's going to be a very complicated triage process," he said, adding that it will not be consistent across all healthcare providers.
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Federal officials with Operation Warp Speed hope that around 50 million people will have received their first of two shots of a COVID-19 vaccine by the end of January, Minister for Health and Human Services Alex Azar said earlier this week.
Two vaccines, one from Pfizer and BioNTech and one from Moderna, have already received emergency approval from the US Food and Drug Administration. A Phase 3 clinical trial for the Johnson & Johnson vaccine has been completed, and another vaccine candidate from AstraZeneca and Oxford University is expected to follow a few weeks later.
Azar has said the government should have enough supplies so that any American who wants a vaccine can get it by the summer of 2021.
In the mid-stage of the rollout, state and local health authorities will have a lot to do to clearly define and communicate who is eligible, said John Brownstein, chief innovation officer at Boston Children's Hospital.
"At the state level, there will be important nuances in terms of eligibility," Brownstein said.
"Everyone wants to know their place in line. I think people will tune in."
Pre-registration, authorization websites and emails
The federal government has left it to the states to implement mass vaccination programs. As with many other policy decisions in the pandemic - from testing protocols to restrictions - states will need to tailor their vaccine launches to their specific needs, including the way they communicate eligibility, Greene said.
The state vaccine distribution plans presented to the CDC earlier this year largely cover how states will communicate with their residents, and the plans vary in terms of how eligible individuals will be informed.
Right now, health care workers who are being vaccinated can learn from their employer which facilities are providing the vaccine. CVS and Walgreens plan to go to tens of thousands of long-term care facilities to give first doses to residents and staff.
Many states' plans say they will rely on traditional media campaigns and mention governor press conferences, contacting community groups, and text and email campaigns.
As the vaccine becomes more available, New York residents are expected to go to a website to find a "tool to verify vaccine eligibility and a location for vaccine administration."
The Colorado and Virginia Department of Health websites have trackers showing that they are still in phase 1a of the rollout.
In Maryland, residents can pre-register for the vaccine through the state's existing vaccination information system, the state plan says. The Ministry of Health sends targeted texts and emails to pre-registered people who have not yet received their vaccine.
According to Greene, Maryland's pre-registration plan is "a pretty innovative approach," but it depends on how many people can use the system.
Online systems for informing people about eligibility are only as good as buy-in, Dai said. For example, a hospital can use a record keeping system like MyChart to send notifications to people who are eligible. However, if a patient has never set up their MyChart, the only way to find out may be by contacting them.
"The key problem is that we don't have a national vaccination waiting list, and we don't even have one for individual states or counties," Dai said, comparing it to the national organ donation registry.
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As part of the expansion of the rollout, a screening tool will also be developed in the CDC playbook for vaccine distribution, with which people can determine their own authorization. That tool then directs them to VaccineFinder.org, an existing platform that connects the public with information on where to get seasonal flu vaccines, travel vaccines, and other routinely recommended vaccines.
Brownstein, who led the development of VaccineFinder.org, said the tool will play an important role in finding a vaccine once they find out they are eligible. He expects the information on COVID-19 vaccines to be available on the website from early 2021.
In November, the Department of Health and Human Services also announced it would work with pharmacy chains in the US to deliver vaccines as supplies become available. This partnership is expected to cover 60% of pharmacies in the United States, HHS said.
CVS said in a statement that once the vaccine becomes more widely available, the public will be able to make appointments to get the vaccine from their pharmacies online or via an 800 number.
"We will drive availability and awareness across multiple channels as the time frame approaches and dates and priorities are set," said Mike DeAngelis, senior director of corporate communications at CVSHealth, USA TODAY in an email.
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"It's something we need to figure out in a hurry."
However, as the rollout moves into the next phases, some states may lag behind others, making it difficult to understand who is eligible at any given time.
The allocation of vaccines is based on the number of adults in each state. However, this does not mean that the number of people at high risk correlates there.
An analysis by USA TODAY published this week found which states are best suited because they have fewer residents in risk categories and which states may be lagging behind. They are still vaccinating health care workers as others approach a wider population.
Greene and Brownstein said it is up to the state and local health authorities to define who falls into each stage to reduce confusion.
"There will be some gray areas and professions where it's not clear which group you fit into," Brownstein said.
When employers simplify the process, those gray areas will become easier, Greene said, but the challenges could remain, especially in smaller work environments with less reach.
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Similar problems could arise when it comes to underlying diseases and comorbidities. Someone's age is easily verifiable for pharmacies and vaccination clinics, but an underlying condition that increases the risk of COVID-19 complications may not be present, Greene said.
Dai described a scenario where someone in the hospital system was treated for an underlying condition but has since moved and plans to get their vaccine from another hospital. If these hospitals use different online records that are not easy to communicate with each other, it may be up to the individual to reach their own reach.
"There has to be a level of expectation that some people won't jump over the line," Brownstein added.
Whether someone would need a doctor's letter to check their condition would have to be determined by the vaccine provider, but Greene said there is a risk of increasing barriers and accessibility for people who may not have access to a family doctor.
"It's something we need to find out in a hurry," she said.
Who will get the vaccine first? Here's who the CDC recommends.
The CDC Advisory Committee on Immunization Practices has recommended that the phased introduction of vaccines should be directed initially to the following groups:
Phase 1a: Frontline health workers and people in long-term care facilities.
Phase 1b: People aged 75 and over and key frontline workers in the following categories:
First aiders such as fire brigade, police
Teachers, support staff, day care workers
Food and farm workers
U.S. Postal Service Employee
Employees in local public transport
Workers in grocery stores
Phase 1c: People aged 65 to 74, people aged 16 to 64 at high risk, and other key workers. The diseases listed are:
Type 2 diabetes
COPD, or chronic obstructive pulmonary disease
Chronic kidney disease
Immunocompromised condition due to organ transplantation
Sickle cell anemia
Smoker (current or with a history of smoking)
Workers in this category include:
Public Health Workers
Transport and logistics workers
Food service employees
IT and communications staff
Public Safety Engineers
Water and sewage workers
Featuring: Elizabeth Weise, Dennis Wagner, Donovan Slack and Aleszu Bajak
Follow USA TODAY's Ryan Miller on Twitter @RyanW_Miller
This article originally appeared in the US TODAY: COVID Vaccine: When Can I Get It? How will I be notified if I am eligible?
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