The UK has now approved three vaccines for use and two are currently being rolled out, while supplies for the Moderna vaccine are not expected in the UK until the spring (Pfizer/BioNTech, Oxford/AstraZeneca and Moderna).The limited availability of vaccines requires prioritisation: NHS guidance indicates that top priority is given to those highly susceptible to COVID-19 infection and high risk of mortality – the elderly, starting with care home residents and their carers, front-line health and social care workers, those who are clinically vulnerable and with underlying health conditions. Considering this, we are wondering, what are the challenging and contentious decisions relating to initial access to the COVID-19 vaccine? Key in this is the inherent tradeoff between health and the economy – andthe extent to which this is being considered in decision making. As vaccine roll-out continues and more vaccines are being approved, what are the likely challenges for implementation and policy going forward?