A primary goal in Phase 1b is preventing deaths and the ethical and equitable distribution of vaccines. With limited vaccine supply, those least able to protect themselves should be prioritized in this phase. Vaccination in this phase will focus on those at greatest risk of getting COVID-19 and those performing critical tasks in support of society who are at a much higher risk of getting COVID-19 on their jobs.

Summary points

• Persons included in Phase 1b are:
  • Persons living and working in shared or overcrowded settings increasing risk of COVID-19 infection
  • Workers in health care settings not vaccinated in Phase 1a
  • Frontline essential workers. The ACIP defines frontline essential workers as those at highest risk for work-related exposure to SARS-CoV-2, because their duties involve being in close proximity (<6 feet) to the public or to coworkers. Frontline essential workers are in sectors essential to the functioning of society and are at an unavoidable, much higher risk of exposure to SARS-CoV-2, above the general population.
• Planning and decisions about COVID-19 vaccination may change as we learn more about the vaccines.

Examples of persons in high-risk settings include those living and working in shared or overcrowded settings, increasing the risk of illness, are listed below. All workers in these settings may not be at greatly increased risk at work.

• Residents and workers in group home settings with behavioral or substance use disorder conditions or for the mentally or physically disabled not previously vaccinated in Phase 1a
• Workers and residents in homeless shelters
• Workers and residents in community training homes (CTHs)
• Correctional facility officials with close inmate contact
• Correctional and immigration detention facility inmates
• Migrant farmworkers living in shared housing or using shared transportation
• Meat- and poultry packing workers or other industrial settings unable to keep distance at work
• Department of Agriculture meat/poultry inspectors

The reason why

• With an overall goal of preventing deaths, consideration should be given to community settings where data shows spread and resulting deaths are high, and where shared space increases contact with the virus and spreading it further.

Workers in high-risk settings in Phase 1b include:

• Hospital medical personnel, support staff, EMS and hospital transport staff not previously vaccinated in Phase 1a
• Hospital volunteers, clergy, food/janitorial/environmental services staff who may be exposed to confirmed or suspect COVID-19 patients not previously vaccinated in Phase 1a
• Community health workers (CHWs) who serve high-risk populations
• Persons administering vaccine (if not vaccinated in Phase 1a)
• Persons performing SARS-CoV-2 testing

The reason why

These workers have a higher risk than other community members because their jobs bring them into contact with persons who may have COVID-19, or items soiled with the virus.

Frontline Essential Workers

• Public safety officers, firefighters not previously vaccinated in 1a.
• Frontline essential workers who are in sectors essential to the functioning of society and are at an unavoidable, substantially higher risk of exposure to SARS-CoV-2, that is, their occupational risk is much greater than the general population. For example,
  • Meat- and poultry packing workers or other industrial settings unable to keep distance at work as shown.

The reason why

Large COVID-19 outbreaks occur in essential settings such as manufacturing, construction, wholesale trade, and animal slaughtering and processing. Close working conditions, close contact with coworkers for long periods of time, crowded work-related housing, and the use of public or shared transportation by workers contribute to outbreaks. Workers who have a lot of contact with the public at a distance of less than 6 feet while doing essential work may be at increased risk. Loss of these services could affect community needs.

Other frontline essential workers include some, but not all, workers in the following sectors:

• Food and agricultural
• U.S. Postal Service
• Manufacturing  
• Grocery store
• Public transit
• Education sector (teachers and support staff members) and child-care

Persons NOT included in Phase 1b:

• Staff in high-risk settings who can avoid being close to confirmed or suspect COVID-19 patients or who have limited contact with the public: administrators, all staff who can work from home, support staff and medical personnel working with confirmed SARS-CoV-2 negative patients.
• LTCF personnel not involved in direct resident care, e.g., administrators, those who can work from home.
• Essential services personnel who are not frontline (i.e., with potential or uncontrolled exposure to SARS-CoV-2)

Temporary residents in South Carolina who fall into Phase 1b share the same risk as permanent residents and can be vaccination in South Carolina.