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As shipments of Pfizer's coronavirus vaccine begin arriving at hospitals in the United States on Monday, businesses and professional groups are lobbying to be considered essential to get early doses.
"Everybody believes that their own workers should be first in line" for vaccine doses, said Jeff Levin-Scherz, co-leader of health-management practice at Willis Towers Watson, a global advisory, broking and solutions company.
Last week, a panel of experts advising the US Centers for Disease Control and Prevention overwhelmingly recommended that the first doses go to the nation's 21 million healthcare workers and 3 million residents of long-term care facilities, who are in the Phase 1a category.
The second deployment of the vaccine, Phase 1b, will include essential workers needed to maintain basic services.
Phase 1c will include adults with high-risk medical conditions and people over the age of 65.
Despite the CDC guidance, state governors have the final say, so the priority line could vary widely by state.
Some states are shifting the responsibility to determine who should be first in line to the health-care industry, arguing that hospitals are better equipped to make the determination.
"They know who is most at risk," Kentucky Governor Andy Beshear said during a news conference on Thursday.
Kansas Governor Laura Kelly said during a conference on Friday that her state considers meatpacking plant workers and grocery store employees to be essential workers, putting them behind medical workers.
Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, told the Los Angeles Times on Thursday that local public health officials may base priority not on occupation but rather on other risk factors, such as having an underlying health condition, being incarcerated, being homeless, working in a factory or living in a multi-generational household.
The Phase 1b category for essential workers has been the subject of the most intense lobbying, according to state and federal authorities, as companies and professional organizations seek to get into the category or move up in the line-or both.
Each state has its own guidelines for who is considered essential, but the CDC provides broad guidance.
According to the CDC, around 87 million workers across the US qualify as non-healthcare but essential workers, including those from the food and agriculture industry, education, transportation, police, firefighters, energy and manufacturing.
"You could be essential in New York but not in Texas, so all of this contributes to the chaos and confusion that employers are having to deal with," Nadina Rosier, a general manager at the Health Transformation Alliance, told The Wall Street Journal on Friday.
The airline industry is asking for early vaccine access, as are associations representing the funeral industry, trash collection companies, broadcasters, bus drivers, teachers and grocery store clerks.
"Priority for us is getting our employees into that 1b group," said Bryan Zumwalt, executive vice-president of public affairs for the Consumer Brands Association, which represents companies that make thousands of household products, from toilet paper to soda. Of the membership's 2.3 million employees, 1.7 million are considered essential, he said.
Within the healthcare worker category itself, pharmacists are arguing for priority. While the CDC's advisory committee included pharmacists in the Phase 1a health worker category, each state interprets the recommendations differently based on its vaccine supply, said Mitchel Rothholz, chief of governance and state affiliates for the American Pharmacists Association, which is urging states to keep its members atop the list.
Dentists also are pushing for priority.
A CDC database includes a letter from the Association of Zoos and Aquariums citing endangered species that need care. "That protection requires trained professionals on site for essential work that cannot be done remotely," the letter says.
Journalists have also lobbied to be made a priority. The National Press Photographers Association asked that journalists who have direct contact with the public be expressly included as essential workers.
Uber Technologies sent letters on Thursday to every US governor, asking for early access to the coronavirus vaccine for its personnel as essential workers. The company sent a similar letter to the CDC and said it will send one to President-elect Joe Biden.
Uber asked Washington state Governor Jay Inslee for Phase 1b vaccine access for the nearly 35,000 people in Washington who earned money on the company's ride-sharing platform during the pandemic.
In a letter, Uber CEO Dara Khosrowshahi wrote, "I encourage you to recognize the essential nature of their work."
The group representing consumer products makers including Procter & Gamble and Coca-Cola has sent letters to state and federal officials urging that their nearly 1.2 million workers be prioritized for the vaccine.
Agencies contributed to this story.