Vaccines are expected to arrive in Washington state this month, but the rollout will be methodical and tiered, with public health leaders prioritizing health care workers who treat COVID-19 patients, as well as health care staff and residents in long-term care facilities .

State health officials have outlined a tentative framework of phases of who should be vaccinated first, including older residents, those with underlying health conditions and essential workers. Specifics of this plan are still in the works, however, as state officials are taking cues from community input, as well as federal guidance.

An initial shipment of 62,400 doses is expected to arrive this month, although this will not be enough to cover everyone in the first prioritized group.

As of Dec. 1, 116 hospitals, health clinics and pharmacies in Washington have enrolled to be vaccine distributors, but many other applications are partially completed or pending. Vaccine distributors had to sign up through the Department of Health, which will function as mission control for vaccine distribution, telling the federal government where to ship doses and how many. Providers that signed up by Dec. 6 are eligible to receive some of the initial doses of the first vaccine, should it be approved.

The Pfizer vaccine will likely be the first to be approved in the U.S. for COVID.

On Dec. 10, the Food and Drug Administration Vaccines and Related Biological Products Advisory Committee will meet to discuss potential emergency use authorization for the Pfizer vaccine. If approved, a work group of providers from West Coast states will meet to evaluate the safety and effectiveness of the vaccine. Once that group approves it, providers can begin administering the first doses in Washington.

The Pfizer vaccine is a two-dose vaccine, with 21 days between doses. The first 62,400 doses shipped to Washington will go to health care workers, and they will all receive their second doses from the second shipment expected this December. State health officials expect to receive about 200,000 doses of the Pfizer vaccine before December ends.

The Department of Health is considering about 20 sites where it could preposition vaccines statewide, said Michele Roberts, acting assistant secretary at the department. These sites already have the ultracold storage available to store the Pfizer vaccine when it arrives. The department will have a finalized list next week of those sites, which they sent to the Centers for Disease Control and Prevention this week.

“That will be part of how we use the first 62,000 doses in the state, but over the next week we’ll look at the providers who have already enrolled to understand the populations they serve and doses they could use within a day or two of the preposition sites (receiving the vaccine). We’ll be placing vaccine orders for other sites as well to get out that full 62,000 allocation,” Roberts said.

Vaccination for health care workers and long-term care residents will continue well into January, as there will not be enough doses available from Pfizer in December to even get everyone in that group their initial doses. The Department of Health estimates that there are 300,000 to 400,000 health care workers that would need to be vaccinated. Additionally, in long-term care facilities there are about 20,000 residents and a little under 40,000 health care staff .

About 60,000 Washington adults are receiving at-home care. Department estimates for the number of home-health care workers were not available.

Long-term care facilities had to enroll with the federal government to be a part of the partnership with CVS and Walgreens pharmacies, which will send vaccine doses and nurses to facilities to vaccinate both residents and staff members.

About 2,200 of the 4,000 long-term care facilities in the state have signed up to be a part of the CVS-Walgreens vaccination program, said Candace Goehring, director of residential care services at the Washington Department of Social and Health Services.

All nursing homes and supported living homes, most of the assisted living facilities and a couple hundred adult family homes enrolled in the program, Goehring said. The program will be crucial to getting vaccines to many facilities that do not have the staffing capabilities or credentials to vaccinate all their residents.

“Many of these facilities don’t have nurses and wouldn’t have a provider,” Goehring said.

Goehring said DSHS will continue to work with the health department to ensure that adult family homes and others receiving long-term care at home receive prioritization to be vaccinated.

FDA committee members are meeting to consider granting emergency use authorization to the Moderna vaccine on Dec. 17, but state health officials do not have an estimate on how many doses of that vaccine they could receive by the end of the year. The Moderna vaccine does not have to be stored at ultracold temperatures, which could give the state flexibility in where they send doses of that vaccine. It is also a two-dose vaccine, however, with four weeks between doses.

Distributing the vaccine to rural parts of the state presents unique challenges. Not only do most critical access hospitals or rural health clinics not have ultracold storage for the Pfizer vaccine, they probably could not accommodate the number of doses per shipment, which is 975.

Pfizer developed a cold-storage shipper, which can keep them cold for 15 days with the dry ice replenished. Roberts said the doses can also be in the fridge for five days after that. Coordinating distribution of doses will be vital to ensuring none go to waste. For rural health care providers, that might mean traveling to get vaccinated or sharing doses in regions.

“If we have a hospital in a rural community, they may not have 975 employees, but maybe some of the other clinics or surrounding hospitals would be willing to come into that hospital to do that,” Roberts said.

Rural hospitals will be important to ensuring the vaccines can get out to rural communities, especially when it comes to identifying people most at risk of severe illness with COVID-19.

“Hospitals will be vital to identifying who that is and helping draw those connections,” said Jacqueline Barton True, vice president of rural programs at the Washington State Hospital Association. “There isn’t just like a, ‘Oh, we will magically know where every person with an underlying condition is and know the strategies we’ll need to get them engaged in this process and come in for two doses,’ so having that community tie with rural hospitals will be really, really huge.”

Here are some other common questions and answers on the vaccines.

When will the vaccine be ready?

Possibly by mid-December. If the Food and Drug Administration grants an emergency use authorization to the Pfizer vaccine after the initial Vaccines and Related Biological Products Advisory Committee meeting on Dec. 10, it will be authorized to be used in U.S. citizens over the age of 16. The committee will meet again on Dec. 17 to discuss the Moderna vaccine emergency use authorization request, which could trigger initial doses of that vaccine being available before 2021.

Who gets access to vaccines first?

The Washington State Department of Health has taken federal guidance and aligned it to its own priorities to create the first phase, called “1A” of vaccine distribution. The first vaccine doses will go to health care workers on the front lines of the COVID crisis, treating COVID patients in the hospital and in long-term care facilities. Residents of long-term care facilities are also first in line for initial doses.

How many people will be vaccinated in December?

Current estimates from the Department of Health show that 200,000 doses could come to Washington state by the end of December. These estimates are only for the Pfizer vaccine, however, and do not take into consideration the possibility that the Moderna vaccine could roll out initial doses before the end of the year as well. It’s important to remember that each person will need two doses of each vaccine to have full protection.

When can the rest of the population be expected to get vaccinated?

The process will take several months. The initial doses expected in Washington state through December are not enough to cover long-term care residents and health care workers in the state to begin with, so Phase 1A will likely continue into the new year. After those groups have been vaccinated, essential workers, older Washington state residents and those with underlying health conditions will likely be next, but details on who exactly is next in line for the vaccine are still being finalized by federal and state authorities. Health officials estimate the vaccine will be more readily available (as more vaccines potentially get emergency use authorization) in spring 2021 and into summer.

Who is going to administer the vaccine?

Pharmacies, health clinics and hospitals could all sign up to be vaccine administrators through the Department of Health. As of Dec. 1, 116 providers are signed up to distribute the vaccine through the state of Washington, with many more applications partially completed or pending. Providers need to enroll with the state before Dec. 6 to be eligible to receive a shipment of the first doses of vaccine. The state will tell the federal government or vaccine makers which of these providers to ship doses to going forward.

Is the COVID-19 vaccine like the flu vaccine?

No. First, most COVID-19 vaccine trials in the latest phases are two-dose vaccines, meaning they require two shots, not one. The Pfizer vaccine requires 21 days between doses. The Moderna vaccine requires 28 days between doses. Secondly, some side effects, like fevers and headaches, have occurred after vaccination during trials, particularly after the second dose of the vaccine. The CDC Advisory Committee on Immunization Practices has recommended that health care providers stagger vaccinating staff in case some workers experience these symptoms.

Who has vetted the vaccine to ensure it’s safe?

The FDA’s Vaccines and Related Biological Products Advisory Committee, made up of infectious disease, pediatric and vaccine medical experts from around the country, will only grant emergency use authorization to a vaccine that has performed well enough in clinical trials to show both quality and safety. Vaccine makers are required to submit their Phase 3 trial database, which requires data from more than 3,000 recipients who have been followed after their vaccination to track adverse events for at least one month following both doses. Additionally, Washington state and other West Coast states have formed a work group that will review the vaccines and ensure their safety before they are administered in Washington.

How many vaccines are there?

As of Nov. 24, there are five vaccines in their final Phase 3 trials, according to the Centers for Disease Control and Prevention. Of those five, only two have asked for emergency use authorization: Pfizer and Moderna. As time goes on and trials continue, it is expected that more companies will ask for authorization, expanding the number of vaccines available to U.S. residents.

Does getting vaccinated mean the end of wearing masks?

No. Both federal and state health officials have cautioned that just because you get a vaccine doesn’t mean you are completely immune. So far, vaccine makers that have released their own data show high but not perfect efficacy rates. The Pfizer vaccine has a 95% efficacy rate, according to the manufacturer, while the Moderna vaccine has shown a 94% efficacy rate, according to their analysis. This means that some people can still get the virus even after being vaccinated. Research continues to figure out how long immunity will last with each of the vaccines and whether the COVID-19 vaccine will become like the flu shot that we have to get every year.

Can kids get the vaccine?

Early clinical trials of the vaccine were not tested in children. The CDC warns that initially, COVID-19 vaccines may not be recommended for children. The Pfizer vaccine could be used for teens 16 and older, if it is granted emergency use authorization, but Moderna’s vaccine is for adults 18 and older. Moderna announced its clinical trials were expanding to kids 12 to 17 late last month.

If you have had COVID-19, should you get vaccinated?

It depends. The CDC currently says there is not enough information to say whether or how long someone is protected from getting COVID-19 again. The Advisory Committee on Immunization Practices recommended this week that health care workers who have not had COVID-19 in the prior 90 days can get the vaccine. This is because the CDC currently estimates that about 90 days after the initial infection a person could be susceptible to reinfection, although this is very rare.