Because initial COVID-19 vaccine supply will not meet demand, rationing will be inevitable. That raises ethical and logistical questions about how policymakers and health systems will make allocation decisions. In addition to addressing the logistical complexity of vaccine distribution, many public health leaders are seeking to address inequities and focus their efforts on vulnerable groups. But questions remain about ordering priorities. When will outpatient clinics that serve homeless populations get doses? What about incarcerated populations? School teachers? A Dec. 5 story in the New York Times notes that "Health care workers and the frailest of the elderly - residents of long-term-care facilities - will almost certainly get the first shots, under guidelines the Centers for Disease Control and Prevention issued. But with vaccination expected to start, the debate among federal and state health officials about who goes next, and lobbying from outside groups to be included, is growing more urgent. It's a question increasingly guided by concerns over the inequities laid bare by the pandemic, from disproportionately high rates of infection and death among poor people and people of color to disparate access to testing, child care and technology for online schooling."
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