Azar says states will decide who gets first Covid-19 shots

States will have final say on how to prioritize who gets the first doses of any coronavirus vaccines, HHS Secretary Alex Azar told reporters on Tuesday.

A CDC vaccine advisory committee is set to meet as soon as the FDA authorizes the first vaccine, to determine which groups should get early access to the shot. But governors will have "final say," Azar said, raising the possibility that Americans could face widely differing distribution plans depending on where they live.

He and other top government officials have said that about 40 million doses of the vaccine will likely be available next month. Pfizer and its German partner BioNTech have filed for emergency authorization from the FDA, and another developer — Moderna — has said it will soon follow suit.

Although public health experts broadly agree that groups at high risk, such as front-line health care workers and the elderly, should be prioritized in any vaccination campaign, there will not be enough doses initially to treat all members of those groups.

"We are not dependent on any delay for ACIP in terms of helping to advise states on prioritization" of vaccines, Azar said of the CDC panel, the Advisory Committee on Immunization Practices. "We hope our recommendations will carry weight with [states] but at the end of the day, they will make that decision."

The timing will be tight: ACIP has said that it will wait until a vaccine is authorized before laying out its priority list. But the federal government's vaccine accelerator, Operation Warp Speed, is planning to ship the first doses within 24 hours of FDA authorization.

Azar said the federal government will not wait for ACIP's recommendations before distributing the first shots.

The CDC panel weighs in: ACIP met on Monday and unveiled the principles that will guide its recommendations. The group says vaccine distribution should aim to address health inequities amid disproportionate Covid-19 cases, hospitalizations and deaths in Black, Latino and Native American populations, as well as long-held distrust of the medical establishment among those groups because of historical abuse and mistreatment.

How the feds will dole out doses: The Trump administration will divide shipments of the coronavirus vaccine to states in December and beyond based on the size of their adult populations, rather than how many Covid-19 cases they have, Azar said.

"We wanted to keep this simple," Azar said. "Once we pass through these initial tranches where we're in a much more of a scarcity situation, we'll eventually get to where we need to be per capita."

Operation Warp Speed officials stuck with the population rationale to avoid having one distribution formula initially and changing it later, he added.

Governors provided limited feedback on how the first doses should be divided up by state, Azar said, noting that they "also wanted to keep it simple."