A coronavirus vaccine produced by Pfizer is days away from winning final approval from federal regulators. It's expected to be quickly followed by the approval of a similar vaccine manufactured by Moderna. 

On its face, this is good news for a public that has become weary of a pandemic that has killed more than 300,000 Americans and cratered the economy. But the vaccine will also present challenges in its vey distribution: Who should take the vaccine first?

Already, there are calls for EMT workers to receive the vaccine as early as possible. The CEO of Uber this week also made a pitch for drivers of the ride hailing to get the vaccine early. 

There is a plan in place by New York health officials to administer doses of the vaccine. At the top of the list: people who living in nursing homes and long-term care facilities. At the end of the line: healthy adults and children who do not fall under key categories of essential worker.  

The push for access to a vaccine raises all sorts of questions surrounding income and race and ethnicity. New York officials are largely following what the federal government has laid out for a vaccine distribution plan. 

Who gets the vaccine when will be largely in a five-phase plan.

Phase 1

In the first phase will include workers in nursing homes and care facility as well as the most at-risk residents as well as frontline workers in ICUs and EMS workers. 

Phase 2

There will then be a second phase that includes first responders like police and firefighters, teachers, grocery store workers, and other essential workers who regularly interact with the public like pharmacists as well as people with high health risks.

Phase 3

The third phase will incorporate people over the age of 65 and people under 65 with underlying health conditions.

Phase 4 & 5

Phase four: all other essential workers. The rest of the population will be vaccinated in the final phase. This process could take as long as the first nine months of the new year. 

Within these phases there will be different subsets of people receiving the vaccine. 

"For example, healthcare workers that regularly interact with patients may be prioritized over those that do not, and ICU and emergency department healthcare workers will likely be prioritized in hospitals if supply is not enough for the entire hospital staff," according to the state's guidance. "All entities receiving the vaccine will be given a level of autonomy to determine the internal order of employee vaccination based on risk and within the boundaries of NYS and federal guidance. To guide prioritization, New York State will collect up-to-date numbers of all prioritization and micro-level prioritizations groups statewide including sub-populations." 

So where will the vaccine go geographically? This could be fraught politically given the upstate-downstate dynamic in New York as well as the income disparities. 

Here's what the state plans to do:

"Once the vaccine is first approved for use, New York State will use up-to-date data to determine which geographic areas of the state may derive a greater public health benefit to receiving early vaccine. This may include areas with higher historical burden of disease or areas that have the highest prevalence of COVID-19. In addition, individual factors for hospitals and nursing homes will be considered including cases per facility in prior 14 days, and vulnerability index of population served. New York will also consider whether the vaccine can be used effectively as a potential outbreak interruption strategy and if so, what the criteria will be."

The COVID-19 pandemic has exposed deep inequalities, both economic and racial ones, in our society. The challenge in ending it will be distributing a vaccine that is available to all who are healthy enough to take it.