California expects the first batch of coronavirus vaccine to arrive in the state in weeks but it’s not yet clear who will get the first shots and when those inoculations begin.

Gov. Gavin Newsom said 327,000 doses of Pfizer’s vaccine should arrive in mid-December. He said more vaccine from Moderna and other companies could soon follow.

That has California finalizing plans for how to distribute the vaccine and determine who should be first in line. On Tuesday, the federal Advisory Committee on Immunization Practices recommended health care workers and nursing home residents be the first to get shots.

In California, there’s broad consensus the state’s 2 million health care industry workers with potential virus exposure on the job should be among those prioritized.

“We want to take care of the healthcare workers so they can take care of you,” Dr. Oliver Brooks, co-chair of the state’s Drafting Guidelines Workgroup, said Tuesday.

But since there won’t initially be enough vaccine to cover them all, the workgroup is drafting detailed guidance outlining who within the group should get first dibs.

Experts have advised the state to prioritize workers in acute care hospitals and those in risky health care work settings or who face more risk themselves due to age or health conditions. Residents of skilled nursing and assisted living facilities will also be prioritized, with the state awaiting federal guidance on where precisely they’ll fit in.

The initial batch of vaccines is expected as California — and the country — grapple with a surge in virus cases and hospitalizations as colder weather pushes more activities indoors and pandemic-weary residents have gathered together. The state on Tuesday reported another 12,000 confirmed cases and a 7-day positivity rate of 7 percent, more than twice what it was earlier this fall.

The U.S. Food and Drug Administration is expected to consider this month authorizing emergency use of two vaccines made by Pfizer and Moderna. Current estimates project that no more than 20 million doses of each vaccine will be available by the end of 2020. And each product requires two doses.

Another Challenge Is That Vaccine Doses Must Be Preserved at Extremely Low Temperatures

California has formed a working group of scientists and health experts who will also review the vaccines for safety and efficacy and to ensure public confidence. Dr. Arthur Reingold, who chairs the state’s Scientific Safety Review Workgroup, said he doesn’t expect any delay in the rollout of these vaccines as group members are reviewing the data within a day of its release to federal officials.

“We will be basically doing our work along a similar time frame,” Reingold said. “I’m optimistic based on what we’ve seen so far, but you know, we need to see the rest of the information.”

Reingold said there is a concern that people may be less inclined to show up for the second, required dose of a vaccine if they experience fatigue and run a fever after the first one. He said studies will need to continue once the vaccine has been broadly administered to assess longer-term efficacy and safety, which is standard practice.

Another challenge is that vaccine doses must be preserved at extremely low temperatures. Brooks said acute care hospitals are more likely to have equipment on site that will keep the doses at the proper temperature.

In Los Angeles, a network of community health clinics bought eight refrigerators and is building dedicated power lines and purchasing back up generators to be able to receive and store vaccine doses, Jim Mangia, chief executive of St. John’s Well Child and Family Center, wrote in a letter to a committee advising on vaccine implementation. Mangia also asked for workers conducting community virus testing to be considered a priority for vaccination.

Within California, counties will handle vaccine allocation in line with state guidance with some room for variation based on local conditions, Brooks said.

Newsom said he would have a distribution plan for the initial vaccines by the end of the week.

Friday is the deadline for states to submit requests for doses of the Pfizer vaccine and where they should be shipped. States will have another week to submit requests for doses of the Moderna vaccine.

“We are expecting over the course of months millions more doses to come in,” Brooks said. “’This isn’t the end. This is the beginning.”