Public health agencies throughout Colorado are laying out plans for distributing a COVID-19 vaccine in both urban and rural areas as several vaccine candidates seek emergency authorization from the Food and Drug Administration.

The exact timeline for a vaccine to be approved remains uncertain, but agencies including San Juan Basin Public Health, based in La Plata and Archuleta counties, are preparing distribution plans based on federal guidelines and state distribution plans.

Vaccine availability is likely to be limited even after FDA approval. In the meantime, officials are stressing the importance of continued adherence to public health guidance like social distancing and masks as case numbers across the country trend upward.

“Distributing a COVID-19 vaccine to the entire state will take time,” Claire Ninde, spokeswoman for SJBPH, said in an email to The Durango Herald. “While the state is planning to act swiftly, it could take several months, or potentially more than a year, to distribute a vaccine to everyone who wants one.”

The Colorado Department of Public Health and Environment has laid out a phased distribution plan for a vaccine. It establishes which populations will be prioritized to first receive the vaccine, because early on, the vaccine is expected to be available in very limited quantities.

According to the distribution plan, the first people to receive the vaccine will be critical workers, including health care workers and first responders as well as people living in high-risk places, such as nursing homes, which have been the site of many outbreaks across the country. This first tier will be followed by other high-risk populations, such as people with chronic illnesses and people working directly with the public. The final tier of distribution is widespread availability to the general public.

CDPHE’s 100-page vaccine plan also lays out how the state anticipates handling vaccine distribution differently in rural areas. For instance, the plan says the state may go outside of the phased distribution plan in some cases, such as a spike of cases in a rural area.

“It is known that areas of rapid and high transmission may quickly overwhelm local health systems especially in rural areas with limited access to hospitals and other forms of health care,” the plan says. “It may therefore make sense to attempt to direct vaccines to emerging hot spots based on timely positivity and transmission rates.”

The plan also says it will prioritize vaccinations for health care workers serving critical populations, including rural and remote populations with few health care providers. In those rural areas, CDPHE says vaccine distribution to the general population will likely be run by a combination of health clinics and pharmacies.

The continued uncertainty as to which vaccine will be first approved also has complicated preparations for distribution. For instance, one vaccine candidate, developed by Pfizer, needs to be stored at “ultra-cold” temperatures. According to CDPHE, facilities with ultra-cold storage capabilities are localized almost entirely in the Front Range, posing challenges for distribution in rural areas.

Other vaccine candidates do not require the same ultra-cold storage, meaning that distribution would likely be less complicated. However, until vaccines are approved by the FDA and public health officials know which ones will be sent to Colorado, public health officials have to prepare for multiple scenarios.

“Our plan for vaccine distribution will depend on which available vaccine(s) the federal government sends to Colorado,” Ninde wrote. “We are preparing for many scenarios.”

For now, in addition to continuing good public health practices, SJBPH is recommending that everyone older than 6 months of age get a flu shot. Although it will not prevent COVID-19, the shot will help keep people safe from another illness that’s currently in season.

Ninde wrote, “Getting a flu shot this year is more important than ever.”

John Purcell is an intern for The Durango Herald and The Journal in Cortez and a student at American University in Washington, D.C.