Who’s first — and last — to get the COVID-19 vaccine in Nevada?

Under a priority system developed by the state based on federal guidance, Nevada plans to make the first doses available to health care workers and to residents and staff in long-term-care facilities.

As more doses become available, the vaccine will be offered to additional people using a tiered system that currently gives priority to those most likely to be exposed to COVID-19, along with groups responsible for the infrastructure that keeps communities operating.

The vaccine is not expected to be available to the general public before spring or possibly summer, health authorities say.

Who gets the vaccine first?

Nevada has divided its population into four tiers for receiving the vaccine. These tiers are subject to change based on changes in guidance from the Centers for Disease Control and Prevention or local conditions.

Health care workers make up a significant portion of the first tier, with workers at acute-care hospitals at the top of the list.

Hospitals will prioritize which staff members will be offered the vaccine first.

“The basic principle when we select which employees receive the vaccine first is their risk of exposure to COVID,” said Dr. Shadaba Asad, medical director of infectious disease at University Medical Center.

Those at greatest risk, she said, include people who work in the emergency room, intensive care unit and dedicated COVID-19 unit, including physicians, frontline nurses and respiratory therapists.

“It’s not determined by what it is that you do, but actually the area that you work in” and the risk of exposure there, she said. “And for us, these are the units that bear the brunt of the exposure.”

Medical personnel are not the only ones at risk in hospitals.

“It could be the person who cleans the floor and delivers the food” in a COVID-19 unit, JoAnn Rupiper, the Southern Nevada Health District’s director of clinical services, said of those who could be given early inoculations.

Other Las Vegas Valley hospitals said they were taking a similar approach to that of UMC.

St. Rose Dominican hospitals are factoring personal risk factors into the equation, focusing their first doses “on health care workers who are at significant personal risk due to age or other factors, and significant exposure risk due to their job and location within our hospitals,” spokesman Gordon Absher said in an email.

Nursing homes and law enforcement

The state estimates that it will receive 23,350 vaccine doses during the first week of shipments. A portion of these will go to CVS and Walgreens staff, who will be vaccinating those who work or live in skilled-nursing facilities, according to a news release from the Nevada Department of Health and Human Services.

Assisted-living facilities also are at the top of the first tier for receiving vaccine. Deaths among residents at skilled-nursing and assisted-living facilities account for about 18 percent of COVID-19 fatalities in the state, according to state data.

In the next week or so, the FDA is expected to authorize emergency use for a second COVID-19 vaccine, this one developed by Moderna Inc. Between the two vaccines, the state expects to receive more than 164,000 doses by the end of December, with the second doses of the two-dose vaccine soon to follow.

Come January, the state expects to have ample vaccine to inoculate everyone in the first tier, which also includes emergency medical services personnel, law enforcement and public safety personnel and Department of Corrections staff, among others.

But will they take the shot?

It’s unknown how many in the first tier will want to get the vaccine when it’s offered. Asad said that vaccination won’t be required at first for UMC staff and that she did not envision it becoming mandatory.

“Vaccine hesitancy primarily comes from a lack of knowledge,” she said. “So one of the efforts that we’ve taken at UMC is to start educating about this vaccine and talking about it way before the vaccine actually hits the hospital. Because you can’t really expect people to make an informed decision when they don’t have all the facts.”

Dr. Andy Pasternak, president-elect of the Nevada State Medical Association, said roughly three-quarters of the health care workers he has spoken with have said they’ll get the vaccine, and that the number is higher among those who treat COVID-19 patients.

“They’ve seen how devastating COVID is by killing people or making people really, really sick,” said Pasternak, chairman of the immunization advocacy committee for nonprofit Immunize Nevada.

Who gets it next?

Under the current state plan, the second group to receive the vaccine would include teachers and child care staff, higher education faculty members, essential public transportation workers, essential retail workers and prison inmates.

As the vaccine rolls out, the Southern Nevada Health District may customize the state’s plan for Clark County, which could mean hospitality workers move into the second tier.

“We might focus on those industries that we consider essential, which would be our casino workers, our hospitality workers,” Rupiper said.

The state’s plan indicates that vaccinations for this second tier will begin in January and continue in February.

The third tier currently includes, among others, those over 65 and people with underlying health conditions, which has triggered concerns among some that these groups are not high enough on the list.

“I am over 65 with underlying conditions and was quite surprised and very concerned that prisoners and others were in tier group two while people like me are in tier three,” wrote a 75-year-old Henderson resident, who said her comment could be used if her name was withheld.

However, Rupiper noted that people living in communal settings are particularly vulnerable to the virus.

“Because they are living together, you really can’t socially distance that group,” she said, adding that providing medical care in such settings also is more challenging.

But Candice McDaniel, who leads Nevada government’s vaccination preparation effort, said Friday that the state may make changes to its tiers depending on recommendations of a CDC advisory committee, which is expected to issue new guidance within the next few days.

Last in line

The fourth and final group to receive the vaccine under the current plan is healthy adults between the ages of 18 and 64.

This is one aspect of the state’s tiers that could be changing: an FDA advisory panel on Thursday recommended the addition of 16- and 17-year-olds to this tier. Younger children are not expected to be approved to receive the vaccine before there is further study of the effects on them.

The medical association’s Pasternak said that vaccine, at first in short supply, is expected to become much more available by the spring, by which time multiple vaccines are likely to be authorized for use.

Rupiper said her team is eager to begin the vaccinations, but made one request.

“We’re really asking for patience from the public. It takes time to get vaccine into a million arms.”

Contact Mary Hynes at mhynes@reviewjournal.com or 702-383-0336. Follow @MaryHynes1 on Twitter.