Washington State Department of Health officials, who are preparing for coronavirus vaccination to begin as early as the middle of next week, issued more detailed guidance Thursday on who should be at the very front of the line for first doses.

Expecting emergency approval of Pfizer’s vaccine in the coming days, the state has already submitted a list of 17 sites to the Centers for Disease Control and Prevention (CDC) outlining where about 32,000 doses could be sent next week. Those doses will be distributed among 13 counties and mostly to hospitals for vaccination of high-risk health care workers. About 1,000 of these initial doses will go to Consonus Pharmacy, which partners with some long-term care facilities.

“There’s just not enough vaccine to get it everywhere it’s needed,” said Michele Roberts, the state Department of Health’s acting assistant secretary.

The state is still deciding where an additional 30,000 doses expected in Pfizer’s initial shipments should go.

Because vaccine will be limited, the department is asking hospitals receiving the first doses to use “clinical judgment” to provide the vaccine for workers who are most at risk, prioritizing people who do not have a recent COVID-19 infection, those directly caring for COVID-19 patients and those performing higher risk procedures, such as intubating patients.

It also suggests prioritizing testing site staff, those handling COVID-19 specimens, high-risk first responders, health workers interacting with high-risk populations and those administering the vaccines, themselves.

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Of the residents of long-term care facilities, those in skilled nursing facilities should be prioritized for the first doses of vaccine, according to the department’s guidance.

Most long-term care facilities won’t see vaccines until later this month or early next year, under a federal partnership with CVS and Walgreens. The pharmacies will administer vaccines on-site for more than 2,600 of the approximately 4,000 facilities in the state, said SheAnne Allen, the state’s COVID-19 vaccine director. The vaccines for this program come out of the state’s supply, and the state can’t activate the program until it can cover half of the doses needed. DOH expects the program to begin Dec. 28.

Several more administrative steps now determine the timeline of first vaccine shipments.

An independent committee of advisers to the FDA voted to approve emergency authorization of Pfizer’s vaccine Thursday, all but ensuring the agency will greenlight the vaccine for shipment.

FDA Commissioner Dr. Stephen Hahn told The Seattle Times Wednesday the FDA will “not waste any time” in deciding whether or not to grant emergency authorization for use of the vaccine.

Another group of experts, who advise the Centers for Disease Control and Prevention, will vote Sunday on additional recommendations for how the Pfizer vaccine should be used.

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Washington state is part of the Scientific Safety Review Workgroup convened by California, which must also approve of the vaccine before it can be administered here.

Once shipments arrive, several of the sites expect to have clinics “up and running within 24 hours,” Allen said.

Each shipment of Pfizer vaccine will contain 975 doses.

The 17 sites expecting vaccine in the first week of shipments all feature ultra-cold storage. Pfizer’s vaccine must be stored at minus 94 degrees Fahrenheit. Vials can also be stored in the insulated “thermal shipper” in which they arrive, if dry ice is added regularly. The state is finishing a contract with a dry ice manufacturer, so health care providers needn’t worry about the material themselves.

Moderna’s vaccine, which trails Pfizer in the emergency approval process by about a week, could be easier to manage. The company says it will maintain stable for about a month with refrigeration and orders can be as small as 100 doses.

If both vaccines are approved, Roberts said the federal government estimates Washington will receive a total of 222,000 doses of the Pfizer vaccine and 180,000 doses of the Moderna vaccine by the end of 2020.

Allen said the Health Department plans to publish a dashboard of vaccine metrics on its website so the public can track the state’s progress.

Seattle Times reporter Asia Fields contributed to this report.