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Table 1. Category, vaccination population groups, estimated number in population group, and tiers for low, moderate, and high/very high pandemic severity

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Tier 1 Table

NOTES: (Appendix A for description of Population Groups)

  1. Across categories, vaccine will be allocated and administered according to tiers where all groups designated for vaccination within a tier have equal priority for vaccination. Groups within tiers vary depending on pandemic severity. Tier 1 is the highest priority group to receive vaccination if there is limited vaccine supply for any pandemic severity.
  2. Persons not targeted for vaccination in an occupational group would be vaccinated as part of the General Population based on their age and health status.
  3. Estimates rounded to closest 50,000. Occupational population group sizes may change if worker populations fluctuate or as plans are developed further and population groups may change in number over time
  4. ACIP recommendations for prioritization would guide tiered vaccination during pandemics with low to moderate levels of severity
  5. Includes military forces and other mission critical personnel, not limited to active duty military or US government employees, who are critical to protecting national security

Table 1. Category, vaccination population groups, estimated number in population group, and tiers for low, moderate, and high/very high pandemic severity

This chart illustrates pandemic vaccination tiers and population groups targeted for vaccination during a pandemic based on pandemic severity, for planning purposes. Vaccine will be allocated and administered according to the Tier Groups which range from Tiers 1-5. There are 3 levels of flu severity: low, moderate and high to very high. The categories that define population groups are: a) Homeland and national security; b) Health care and community support services; c) Other critical infrastructure; and d) the General population.

The first category Homeland and national security indicates that the group “deployed & mission essential personnel” are targeted as Tier 1 for vaccination for all three levels of pandemic severity. The estimated number representing this group is eight hundred fifty thousand. The groups “essential military support and sustainment personnel, intelligence services, National Guard, and other domestic national security personnel are designated as Tier 2  under moderate and high/very high severity levels. The estimated combined number representing these groups is one million four hundred and fifty thousand.  The Tier 3 group in this category of Homeland and national security, includes “Other active duty military and essential support personnel”, under the moderate to high/very high severity level. The estimated number representing this group is one million five hundred.

The 2nd category “Health care and community support services” indicates that “Public health personnel, Inpatient health care providers, Outpatient and home health providers, Health care providers in long-term care facilities, and Pharmacists and pharmacy technicians” as designated as Tier 1 for vaccination under all three levels of severity. The estimated number representing these groups is eight million four hundred and twenty five thousand.  The population groups “Community support and emergency management, and Mortuary services personnel” are designated as Tier 2 for moderate to high/very high severity levels. The estimated combined number representing these groups is six hundred and fifty thousand.  Other health care personnel groups fall under Tier 2 (moderate severity) and Tier 3 high/very high severity level. The estimated number of representing this group is three hundred and fifty thousand.

The 3rd category “Other critical infrastructure” includes “Emergency services and public safety sector personnel such as EMS, law enforcement, fire services”, and “Manufacturers of pandemic vaccine and antivirals” as Tier 1 targeted for vaccination under all three severity levels. The estimated number representing these groups is two million fifty thousand. The groups are “Communications/information technology, Electricity, Nuclear, Oil and Gas, Water sector personnel, and Financial clearing and settlement personnel” are listed as Tier 2 for high/very high severity levels. The estimated number representing these groups is two million six hundred twenty five thousand. The groups “Banking and finance, Chemical, Food and agriculture, Pharmaceutical, Postal and shipping, Transportation sector personnel” (in other words critical infrastructure with greater redundancy) and other government personnel are designated as Tier 3 for high/very high severity levels. The estimated number representing these groups is three million eight hundred thousand.

The 4th category is the “General population” and it indicates that “Pregnant women, Infants and toddlers 6-35 months old” are designated as Tier 1 for all three severity levels. The estimated number representing these groups is fifteen million. The groups “Household contacts of infants less than 6 months old and Children 3-18 years old with high risk conditions” are listed as Tier 2 for all three severity levels. The estimated number representing these groups is eleven million five hundred thousand. Children 3-18 years old without high risk condition” fall under Tier 2 (Low to moderate severity) and Tier 3 (high severity). The estimated number representing these groups is sixty two thousand.  Adults 19-64 years old with high risk condition are designated as  Tier 2 (low severity), Tier 3 (Moderate severity) and Tier 4, (High/Very high severity).  The estimated number representing this group is thirty eight million.  Adults 65 years old and older are listed as Tier 2 (low severity), Tier 3 (moderate severity) and Tier 4 (high/very high severity).  The estimated number representing this group is forty one million. And Healthy adults 19-64 years old are included as Tier 3 (low severity), Tier 4 (moderate severity) and Tier 5 (high/very high severity). The estimated number representing this group is one hundred thirty two million.

Figure 1. Vaccination tiers and population groups for a high/very high level of pandemic severity

Vaccination tiers and population groups for a high/very high level of pandemic severity.

* Based on 2015 U.S. populationExternal of 321 million people

Figure 1. Vaccination tiers and population groups for a high/very high level of pandemic severity

This figure illustrates and compares how various occupational groups, high risk populations and healthy adults would be distributed among the five Tiers during a high or very high level of pandemic severity. Numbers associated with those vaccinated under each Tier group is based on the 2015 U.S. population of 321 million.
Those in Tier 1 includes the following Occupational Groups: Deployed personnel, Public health personnel, Critical healthcare, Pharmacists and pharmacy technicians, EMS, law enforcement and fire services, and Pandemic vaccine and antiviral drug manufacturers. High Risk Population groups in Tier 1 in this severe scenario include pregnant women, infants and toddlers. The total number of combined groups equals twenty six million.

Population groups in Tier 2 includes the following Occupational Groups: Essential military support personnel, National Guard, Intelligence services, Other domestic national security, Mortuary services, Other health care personnel, Community services, Communications, IT and utilities, and Critical government operational and regulatory personnel. Tier 2 High Risk Population groups in this severe scenario include Household contacts of infants less than 6 months old and high risk children. The total number of combined groups equals sixteen million.

Those in Tier 3 includes the following Occupational Groups: Other active duty, Other healthcare, Other critical infra-structure sectors, and Other critical government. Tier 3 includes only one High Risk Population group of healthy children in this severe scenario. The total number of combined groups equals sixty-eight million.

High risk population groups in Tier 4 during a severe/very severe pandemic includes High Risk Adults and Adults 65 years old and older. The total number of high risk people is seventy nine million.

Tier 5 during a severe pandemic includes Healthy Adults 19-64 years old. The total number of this group is one hundred and thirty two million.