Covid-19 vaccines, while highly anticipated, are also the subject of much concern.

Doling out hundreds of thousands of vaccines, many of which require multiple doses and some level of refrigeration, begs the question: How, exactly, can this be pulled off?

A Covid-19 vaccination plan released earlier this month by the state offers a window into what this process might look like in New Hampshire.

Who gets vaccinated first?

Covid-19 vaccines will likely be limited at least within the first couple of months, which means the state will have to decide who gets first dibs on the limited supply.

The state has adopted a four-phase process for distributing the vaccine. Within each phase, the state plans to start the allocation process in areas with the highest Covid-19 case counts to help contain the spread of the virus.

In phase one, vaccines will go to first responders, including firefighters, police officers and EMS workers, high-risk health workers, and adults living in nursing homes and assisted living facilities. Next, adults living in overcrowded settings and those who have conditions that put them at “significantly higher risk” for developing a severe case of Covid-19 will have access to the vaccine.

Aside from the initial distribution to first responders, residents in nursing homes and health workers, decisions on the order of distribution aren’t set in stone, according to the document. The order of distribution may change as the state evaluates national recommendations and state epidemiologic patterns.

Tentatively, the second phase will make vaccines available to school staff, older adults not counted in the first phase, those with conditions that put them at “moderately higher risk” of developing a severe case of Covid-19, prison residents and staff, people and staff in homeless shelters, and group homes. Workers in highrisk settings who work in industries that are “essential to the function of society” are also included in this phase.

In phase three, children, young adults and workers in other essential industries will get access to the vaccine. Vaccines become available to everyone else during phase four.

How will the vaccine be distributed?

The state plans on using a combination of government and non-government distribution sites to administer the vaccine.

The state has a network of public health workers across the state who are responsible for coordinating local health efforts, like administering flu shots or reducing drug misuse. According to the state’s vaccine plan, the 13 regional networks each have their own distribution plans for disseminating the vaccine. Each administrator will take an online training course from the CDC about the best practices for handling the vaccines, social distancing at a vaccine site and wearing personal protective equipment.

Vaccines will also be distributed to hospitals, to vaccinate their staff, and pharmacies, to help vaccinate vulnerable populations.

Most potential vaccines in late stages of testing require some level of refrigeration, which adds an added level of difficulty for distribution. One vaccine, created by Pfizer and BioNTech, requires a deep freezer that reaches-94 degrees, which many providers do not already have in their offices. Using federal funding, the state has purchased 13 refrigerators, 16 freezers (including one ultracold freezer) and 42 devices that can be used as portable refrigerators or freezers.

How will vaccinations be tracked?

Right now, New Hampshire is the only state without an immunization registry.

In anticipation of Covid-19 vaccines, the state is working to quickly stand up a centralized database, where providers would input who is vaccinated and which vaccine they received. However, it’s not guaranteed this system will be operational before vaccinations are approved. The state may instead rely on a CDC management system instead and then transfer the information once the state database is implemented.

Most of the vaccines in the late stages of testing require multiple doses, which makes the database even more important to track when second doses should be administered. The state is currently exploring options to notify people when their second doses are due, like text message reminders and small cards with vaccination dates that are handed out at their first appointment.

This article is being shared by partners in The Granite State News Collaborative. For more information, visit collaborativenh.org.