There is no enforcing, just honor system. Which sounds like a horrible idea. It is, and it's why I've been trying to explain why I'll wait a bit. Primary care physicians could have forwarded people with severe conditions to their HCN, and that should have been the group after 75+ and healthcare workers. Far from perfect, it would be subjective, but at least you would capture most people who really need the vaccine. As it stands, you could have lung cancer and a healthy 20 year old jumps in front of you. I do think the DHS guidance allows for 'carrier-level prioritization' within the group or something to that effect, so it does seemingly allow PCPs to use their allotment in a way that targets the most vulnerable. So, there's that.