Health care workers with the highest exposure to coronavirus will receive the first vaccines, followed by residents and staff in nursing homes and then first responders, according to the rollout plan the state of Tennessee has just released.

The state expects to receive about 57,000 doses of the Pfizer vaccine in mid-December.

Because it estimates the size of the group at most risk is 450,000 people, the first to actually get the shots will be high-exposure health care workers with personal high-risk factors, including being age 65 and older or having underlying health conditions.

The people in the high-priority group – Phase 1a1 under the state’s plan – include workers with direct patient contact in emergency rooms but also those exposed to infectious materials, including people who sanitize rooms.

This category also includes home health care staff with high exposure and people who have been staffing mass testing centers.

The second priority group – Phase 1a2 – includes the estimated 100,000 people in health care who have direct contact with patients, from primary care providers in clinics to dentists, but also pharmacists, people who provide rides to appointments and out-patient therapists.

The first members of the general public will be next in line in phase 1b, which will include adults with two underlying conditions. Dementia is one of the underlying conditions. So is cancer. This group is expected to be 1.2 million people.

The report does not give dates for when the various phases will begin, but the state expects the supply of vaccine will rapidly increase after the first batches are received.

“We anticipate vaccine availability will increase substantially over the first quarter of 2021, allowing rapid movement from Phase 2 to Phases 3 and 4,” said Shelley Walker, director of the office of communications and media relations for the Tennessee Department of Health.

The state is expecting shipments of both the Pfizer and Moderna vaccines. Both require two doses. Immunity does not develop until a week or so after the second shot, or about a month after the first one.

The next largest group, an estimated 2.55 million people, including teachers and day-care providers, will be next in line for the vaccine, likely in late winter or early spring.

This group also includes the thousands of people who work in critical infrastructure jobs, include grocery employees and people who work in shipping, agriculture and retail. The category also includes corrections facilities, both staff and residents, and healthy people age 65 and older.

Phases 3 and 4, the last phases, include 2.5 million people in a wide swath, starting with young adults and those who work in industries producing goods. College campuses will receive vaccines during Phase 3. People who work in entertainment, potentially professional athletes, will also be covered in Phase 3.

Phase 4 includes all others.

The shots will be free.

In Shelby County, the average citizen can expect to be vaccinated in the spring, in a timeline that could run from March to June, according to Alisa Haushalter, director of the Shelby County Health Department who is leading the design of the local effort.

The big-picture design is that health care systems will be in charge of vaccinating their high-risk patients and employees in Phase 1a1.

“What we know locally, and we’ve talked about this relative to health care systems, is we need to have sufficient workforce to be able to quickly put the vaccine in the field and administer the vaccine,” Haushalter said Thursday, Dec. 3.

She expects the general public will be vaccinated in two drive-through stations in Shelby County.

The Health Department is recruiting medical workers who can give immunizations, including pharmacists and licensed EMTs.

“We encourage anybody, that could be someone who’s retired and licensed, somebody who has extra time and wants to volunteer to serve, to sign up for the Medical Reserve Corps,” she said. 

“They can assist with anything from signing people up to helping people park to actually giving vaccine,” Haushalter said.

Nearly as a big a job will be designing the education campaign to encourage the public, split nearly in half on the value of the vaccine in national polls, to get it.

“There are challenges with people accepting vaccine for a variety of reasons. Those can be philosophical or religious in a variety of different ways that can also be medical. But we do know in Shelby County particularly, some populations are less likely to be vaccinated,” Haushalter said.

Part of the challenge, says Dr. Stephen Threlkeld, infectious disease physician caring for COVID-19 patients at Baptist Memorial Hospital-Memphis, is making sure people understand the rollout and the steps built in to make it fair.

“Those things are critical because we need to instill trust in people,” Threlkeld said. “That trust is not at an all-time high right now for a number of reasons, maybe just polarity, maybe things that have happened in the recent past, but we need to make sure that people understand it.”

Part of that will require listening to people’s fears, including worries that safeguards were dropped in the speed to the develop vaccines.

“There are a lot of concerns out there. Some people think, ‘Well, I don’t really think this works. I think the data aren’t very good.’ We need to speak to that. We need to put those data out there,” Threlkeld said.

And for people who think the process was rushed, Threlkeld says it is important for them to know that the red tape associated with clinical trials did move “pretty quickly,” but the actual science did not.

“We need to explain that to folks,” he said.