America's top public health agency - the Centers for Disease Control and Prevention (CDC) - on November 23 released its first blueprint of a four-pronged ethical basis which will determine how the coronavirus vaccine could be released to reach more than 261 million people who fall into the category of essential workers.

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A high-powered Advisory Committee on Immunisation Practices responsible for making vaccine recommendations while supply is limited laid out four principles that will guide allocation: Maximise benefits and minimise harms; Promote justice; Mitigate health inequities; Promote transparency. Four candidate groups have been identified as highest priority: Health care personnel (21 million), adults with high risk medical conditions (more than 100 million), adults over 65 (more than 53 million) and "other essential workers" (87 million).

The current planning scenario estimates that in the first weeks spanning December and January, only about 20 million doses might be available. In that scenario, the Advisory Committee's view is clear: 'Health care workers first'. "Published frameworks for COVID-19 allocation and ACIP discussions indicate a clear consensus that the first allocation of COVID-19 vaccine supplies should be directed to health care personnel, discussion of allocation to the other three groups is ongoing. As additional vaccine supplies become available, other groups may be vaccinated concurrent with health care personnel."