After the first round of coronavirus vaccines is administered, state and local officials largely will not be able to ensure that the rest of the process puts high-risk people first.

Between the lines: Experts have spent months debating the ins and outs of a complex prioritization system for these vaccines, all in the hopes of saving as many lives as possible. But the actual process will likely rely heavily on the honor system.

The big picture: It’ll be relatively easy to ensure that the highest-priority groups — health care workers and nursing-home residents — are the ones who actually receive the first vaccine doses, because hospitals and long-term care facilities can just go through their staff and resident rosters to figure out who should be offered a vaccine.

• “Right now we’re very much focused on getting it to the hospitals and the nursing homes, and they’ll be what we call a closed point of distribution,” said Bryan Mroz, Acting Assistant Secretary of the Maryland Department of Health.

But after that, enforcement gets harder. Experts have said the next round of doses should be focused on people who are most at risk to catch or spread the virus, or for serious illness. That would include many service workers and people with underlying health conditions.

• But there aren't great enforcement tools to make sure that's how things work.
• “Eventually you'll get to the point where there’s a lot of providers and distribution points involved in this plan, and it’s going to be harder and harder to ensure you adhere strictly to these priority groups. I’m sure there will be a point where we see line jumping,” said Josh Michaud, associate director of global health policy at the Kaiser Family Foundation.
• “As far as enforcement, states will try to direct vaccines as best as they can to reach the populations they want to, but once they’re at those distribution points, it’s hard to control this process,” he added.

How it works: Health care providers administering vaccines must enroll in a federal program and sign a provider agreement written by the CDC.

• The first stipulation is that providers must administer coronavirus vaccines in accordance with guidance by the Advisory Committee on Immunization Practices, the federal panel recommending how to distribute vaccines.
• But providers will likely have to take people’s claims that they’re members of certain priority groups at face value.
• “I doubt they’re going to require a lot of documentation. If you say you have diabetes, they’re not going to want to see your blood sugar,” said Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security.
• “I think we do have to depend to a significant extent on people’s honesty, and to some extent, it’s an honor system. You can check age…but the rest of it you really can’t.”

Yes, but: Given the level of vaccine hesitancy in the U.S., some experts said they’d be thrilled if line-skipping ends up being our biggest problem.

• “Of all the things that are keeping me awake at night, this is not one of them. If the order in which some people get vaccinated is different than the ideal, at least some people are getting vaccinated,” Toner said. “I’d rather have people so eager to get a vaccine that they find a way to game the system than people not wanting to get vaccinated.”
• “That’s a problem I kind of want to have — people lined up to get” vaccinated, Mroz added.