A coronavirus vaccine should be strictly rationed when it is first released, according to a report commissioned by the trump administration that highlights the political challenges of rolling out the biggest public inoculation programme in us history.

The national academies of sciences, engineering, and medicine released a report on friday morning recommending that frontline healthcare workers in minority communities should be the first group to receive a vaccine, while younger people with no underlying health conditions will have to wait until later.

In a sign of how difficult it will be to make sure the vaccine is distributed fairly while production is being scaled up, the report even suggests local health departments could hold lotteries to decide who receives it after all the priority groups have been served.

Helene gayle, the co-chair of the committee that wrote the report, told the financial times: in the initial phases, if there is a scarce vaccine, we should look to reduce morbidity and mortality first, rather than focusing on stopping transmission.

But she added that lack of demand could end up being as big a problem as too much if americans continue to lose confidence in the safety of a vaccine. as critics have taken aim at donald trump, president, for rushing a vaccine approval to boost his chances of re-election, recent polls have shown nearly half of all adults in the us say they would not receive one if it were released today.

We need a massive public education campaign to make sure we build confidence in people to take the vaccine, dr gayle said.

Public health officials in the us say they are optimistic that a vaccine will be approved for use by at least some sections of the population by the end of the year, but it is not likely to be widely available until next summer.

Anthony fauci, the head of the national institute of allergy and infectious diseases, has predicted there could be about 100m doses available by the end of the year, enough for roughly 30 per cent of the us population.

In the first few months after a vaccine is released therefore, health authorities will have to ration doses for those who need it most. in an attempt to remove some of the likely political controversy from those decisions, the centers for disease control and prevention and the national institutes of health jointly commissioned dr gayles committee to make recommendations.

The committees report recommends taking a four-stage approach. in the first stage, frontline healthcare workers such as doctors and ambulance workers should receive the vaccine first, followed by older people living in communities such as care homes and people of any age with serious underlying conditions. those conditions include cancer, obesity and type two diabetes.

This group consists of about 50m people, and so is likely to take up all the vaccine doses that dr fauci has said are likely to be available in the month after it is authorised.

The next group consists of a further 100m people. it would include people over 65, school staff, childcare workers, as well as residents and staff of facilities where it is difficult to socially distance, such as prisons and homeless shelters.

Remaining essential workers would be included in the third phase, as would children and young adults if a vaccine has been approved for them. only after that would there be a fourth and final phase where everyone in the us would be eligible.

Within each of these phases meanwhile, the reports authors recommend prioritising black, hispanic and native american communities, which have been disproportionately affected by coronavirus. it says health departments should do this by sending doses first to the 25 per cent of areas with the highest minority populations.

But in a sign of the difficult choices that will have to made even when there is wider access to a vaccine, the report considers the possibility that there might be shortages once the vaccine is available to the general population.

Ideally, these individuals would be willing to participate in an egalitarian process (such as a lottery) if there are persistent local or regional shortages in this phase, it suggests.

The report will now be assessed by cdc, which will make its own more specific recommendations once a particular vaccine has been approved.