Failing to put the most vulnerable Americans at the front of the line for coronavirus vaccines will exacerbate the gaping racial and ethnic disparities that have characterized the pandemic, experts say.

Why it matters: The Americans most vulnerable to the virus are disproportionately people of color. And there are a lot of reasons to doubt that vulnerable people will actually end up getting their shots first, despite some efforts to make that happen.

The big picture: The U.S. has spent months debating the order in which people should be vaccinated, beginning with health care workers and nursing home residents, then broadening out to account for risk factors like age, pre-existing conditions and front-line employment.

• Both states and the federal government have incorporated equity into their vaccine distribution plans, a nod to the pervasiveness of pandemic disparities.
• But there won't be many good ways to enforce those priorities, in practice. Adherence will largely depend on an the honor system.

Perhaps even more threatening is that vulnerable populations tend to be harder to reach and more hesitant about receiving the vaccine.

• Experts say that if these obstacles aren’t addressed early, the most vulnerable Americans — specifically people of color — will be left behind once again.
• “The attention to this theme is because we all are nervous about those disparities persisting,” said Utibe Essien, a professor at the University of Pittsburgh School of Medicine.

What they’re saying: “If we’re sincere about prioritizing groups, we want to make sure the prioritized groups also take the vaccine,” said Harald Schmidt, a professor at the University of Pennsylvania's Department of Medical Ethics and Health Policy. “This is a piece we haven’t actually done yet.”

• Rural Americans, Black Americans and essential workers have some of the highest levels of vaccine hesitancy in the country, according to recent KFF polling.
• Reaching Black Americans, who are disproportionately likely to be essential workers, is particularly difficult due to decades of racism within the health system, experts say.

Zoom in: Experts say there are some practical ways to preserve the order of the line.

• Ease of access is key. It’s important to make sure that “there are a lot more vaccines where worse-off people live,” Schmidt said.
• And those vaccines need to be administered in a setting that vulnerable people can comfortably access, like a local church. “We can ensure that folks don’t have to go to the hospital to get their COVID vaccine,” Essien said. “Making the right choice the easy choice is something we’ll have to continue to deal with.”

The bottom line: “This is a generation defining event,” Schmidt said. “If we don’t seize that opportunity, the damage could be significant and lasting.”