For millions of Americans this holiday season, the most critical line they face is not for COVID-19 testing, vaccines, or unemployment benefits, but rather the long wait at food banks and pantries across the country.

As the toll of the pandemic worsens, 54 million Americans are food insecure, many for the first time, due to economic and health impacts.  Lines of vehicles or persons on foot at food banks/ pantries sometimes entail hours of waiting. Most people in line have exhausted other options – their own savings, temporary payments, SNAP benefits, school lunch programs, churches, family, and friends. Others who are hungry cannot queue at all due to age, illness, disability, lack of transportation, or care duties for family members. Chronic lack of access to food impacts their physical, mental, and emotional health.

In normal times, most food pantries feature store-like settings allowing recipients to select foods themselves. The pandemic has driven many pantries to abandon these typical distribution approaches. Instead, limited supplies are sorted, boxed, and distributed to customers on a largely “first-come, first-served” basis. Assessing consumers’ qualifications has given way to rapidly serving as many Americans as possible.

While employees and volunteers at food distribution sites risk their own safety and health to assist consumers, the desperate need for food has led to a supply gap estimated at 10 billion pounds of food from September 2020 to June 2021. Many at-risk Americans are left empty-handed.

Over the last several months, food distribution sites in California, Illinois, Michigan, Mississippi, Ohio, Pennsylvania, and elsewhere could not meet consumer demand. Feeding Texas, an association of the state’s food banks, reported having to turn people away at approximately 30% of its distribution sites in April 2020 when supplies were depleted.

As COVID-19 infections escalate nationally, food banks/pantries confront an ethical crisis: what to do in sustained public health emergencies when demand overwhelms supply?

Ethical principles beyond basic fairness should be considered to blunt the impact of these shortages. As with distributions of limited emergency medical resources, preventing unnecessary morbidity and mortality is key. This means ensuring that those at highest risk of hunger and corresponding health impacts are not unfairly disadvantaged.

Distribution strategies must reach at-risk populations that face barriers to access, like limited transportation or caretaking duties. When supplies run out, people with unmet needs should be prioritized as new resources become available. Community partnerships between food pantries, other non-profits, and transportation services can help reach those unable to reach the lines.

Stigma stops many people who are at-risk of and experiencing hunger from going to distribution sites. Some undocumented immigrants fear inquiries about their citizenship. Others may hesitate to resort to pantries because of a sense of pride. Fighting stigma starts with an environment focused on personal dignity, including diverse workforces and volunteers at pantries, and transparent discourse focused on food justice rather than “personal responsibility.”

Truly accessible sites also respect recipients’ dietary, cultural, and religious food preferences. For example, pantries should consider setting aside specialty boxes of food for people with diabetes or other medical conditions. Accommodating these preferences is a logistics challenge, but it helps overcome another one: waste. Even slight tailoring of limited food resources to match consumer preferences helps assure that the food is used efficiently at home, subsequently reducing recipients’ demands on limited supplies.

Most critically, food banks/pantries must replenish their available supplies. Inventories are shrinking even as lines grow. The costs of purchasing foods by banks have risen. Donations via grocers and restaurants are way down. Public and private sector financial support for food banks/pantries are more essential than ever. When pantries go bare, many Americans simply have no other place to turn in an emergency.

Assuring fair, efficient, and ethical access to food among at-risk populations is not easy. Yet, adaptations to assure greater equity in emergency food distributions can alleviate hunger and resulting health conditions affecting millions of Americans.

Sarah Wetter is a law fellow at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center.

James G. Hodge, Jr. is the Peter Kiewit Foundation professor of law and director of the Center for Public Health Law and Policy at Sandra Day O’Connor College of Law at Arizona State University.