If a COVID-19 vaccine is ready next month, Texas health officials predict it won’t be widely available to Texans until at least July.

Under the state’s vaccine distribution plan, vulnerable people, including health care workers, older people and people with underlying medical conditions would likely be the first to get the vaccine in the early months that it’s available.

The estimated timeline presented at a meeting of health officials Monday hinges on the COVID-19 vaccine being approved before the end of the year, though it remains unclear whether that will happen. But the allocation plan provides more information about who will be first in line to get a vaccine in Texas and how long it might take before vaccines are accessible to public at large.

“Just on the face of it, the vaccine allocation will be a complex and demanding task,” said Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, at a teleconference meeting Monday. “We don’t know when a vaccine will arrive. We don’t know which vaccines will arrive. We don’t know how much of any given vaccine will arrive.”

Imelda Garcia, associate commissioner for the DSHS Division for Laboratory and Infectious Disease Services, presented the plan and estimated timeline Monday and said they were based on the latest information from the Centers for Disease Control and Prevention, which will likely change in the coming days.

“As you can imagine, we’re in a very fluid situation with new information about vaccine development coming just about every other day,” Garcia said.

The state’s new vaccine distribution plan points to previous challenges in the pandemic with testing availability and personal protective equipment shortages. It assumes that at first, the state won’t be able to keep up with demand, and at times supply will be insufficient even for those who will be prioritized for vaccination.

There is no authorized vaccine for COVID-19 yet, though there are several in different phases of development. The state’s timeline will be updated when officials know more about the vaccine’s availability, said Chris Van Deusen, DSHS spokesperson.

The plan has a phased approach and says “vaccine supply will be limited at the beginning of the program, so initial allocations must focus on providers and settings that can vaccinate and conduct outreach to limited vulnerable and frontline populations.”

The state estimates there are over 5 million people who are vulnerable or work in front-line jobs that expose them to the virus. This includes over 3.9 million adults who are 65 or older; over 638,000 health care personnel; over 327,000 acute care hospital employees; over 137,000 nursing home residents; and over 66,000 emergency medical workers.

For people who are 18 or older, the state estimates over 9.4 million have underlying medical conditions that could increase their risk for severe illness associated with COVID-19.

These are the groups that may be prioritized for vaccines in Phase 1, which is estimated to span late November and December. The prioritization could also include some people of color and Texans who are incarcerated, detained, homeless or living on college campuses. It could also include people who are disabled or uninsured.

“Final decisions are being made about use of initially available supplies of COVID-19 vaccines,” the plan says.

The plan includes an Expert Vaccine Advisory Panel to develop guidelines and make recommendations that may include “equitable distribution across urban and rural communities” and considering federal guidance for vulnerable populations.

In Phase 2, an increased amount of vaccines will become available. But Texas will still prioritize critical areas such as long-term care facilities and rural communities with specialized vaccine teams that could be deployed as needed. During this phase, some healthy people could potentially access vaccines with a larger selection of providers including pharmacies, doctors’ offices, clinics and public health sites.

In Phase 3, which is projected for July in the timeline, the state expects there to be a sufficient supply of vaccine doses available to most anyone who wants it.

The plan assumes that people will need two doses of the vaccine separated by at least 21 or 28 days, and that the vaccine will have to be refrigerated or frozen.

To create the plan, the state relied on its previous experience handling and response to the H1N1, or swine flu, pandemic. DSHS said in the plan that those efforts led to major success in vaccine distribution and overall communication.

“For H1N1, much of the planning for pandemic influenza was based on a worst-case scenario (i.e., projections concerning H5N1 avian influenza), but public health officials, emergency responders, and other response partners adapted quickly to this event as it was presented,” the plan reads.