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COVID-19 Vaccine Allocation: Modeling Health Outcomes and Equity Implications of Alternative Strategies.

ABSTRACT: Given the scarcity of safe and effective COVID-19 vaccines, a chief policy question is how to allocate them among different sociodemographic groups. This paper evaluates COVID-19 vaccine prioritization strategies proposed to date, focusing on their stated goals; the mechanisms through which the selected allocations affect the course and burden of the pandemic; and the main epidemiological, economic, logistical, and political issues that arise when setting the prioritization strategy. The paper uses a simple, age-stratified susceptible-exposed-infectious-recovered model to quantitatively assess the performance of alternative prioritization strategies with respect to avoided deaths, avoided infections, and life-years gained. We demonstrate that prioritizing essential workers is a viable strategy for reducing the number of cases and years of life lost, while the largest reduction in deaths is achieved by prioritizing older adults in most scenarios, even if the vaccine is effective at blocking viral transmission. Uncertainty regarding this property and potential delays in dose delivery reinforce the call for prioritizing older adults. Additionally, we investigate the strength of the equity motive that would support an allocation strategy attaching absolute priority to essential workers for a vaccine that reduces infection-fatality risk.

SUBMITTER: Ferranna M

PROVIDER: S-EPMC8089031 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe development and widespread use of an effective SARS-CoV-2 vaccine could prevent substantial morbidity and mortality associated with COVID-19 and mitigate the secondary effects associated with non-pharmaceutical interventions.MethodsWe used an age-structured, expanded SEIR model with social contact matrices to assess age-specific vaccine allocation strategies in India. We used state-specific age structures and disease transmission coefficients estimated from confirmed incident cases of COVID-19 between 1 July and 31 August 2020. Simulations were used to investigate the relative reduction in mortality and morbidity of vaccine allocation strategies based on prioritizing different age groups, and the interactions of these strategies with concurrent non-pharmaceutical interventions. Given the uncertainty associated with COVID-19 vaccine development, we varied vaccine characteristics in the modelling simulations.ResultsPrioritizing COVID-19 vaccine allocation for older populations (i.e., >60 years) led to the greatest relative reduction in deaths, regardless of vaccine efficacy, control measures, rollout speed, or immunity dynamics. Preferential vaccination of this group often produced relatively higher total symptomatic infections and more pronounced estimates of peak incidence than other assessed strategies. Vaccine efficacy, immunity type, target coverage, and rollout speed significantly influenced overall strategy effectiveness, with the time taken to reach target coverage significantly affecting the relative mortality benefit comparative to no vaccination.ConclusionsOur findings support global recommendations to prioritize COVID-19 vaccine allocation for older age groups. Relative differences between allocation strategies were reduced as the speed of vaccine rollout was increased. Optimal vaccine allocation strategies will depend on vaccine characteristics, strength of concurrent non-pharmaceutical interventions, and region-specific goals.

Project description:BackgroundAnticipating an initial shortage of vaccines for COVID-19, the Centers for Disease Control (CDC) in the United States developed priority vaccine allocations for specific demographic groups in the population. This study evaluates the performance of the CDC vaccine allocation strategy with respect to multiple potentially competing vaccination goals (minimizing mortality, cases, infections, and years of life lost (YLL)), under the same framework as the CDC allocation: four priority vaccination groups and population demographics stratified by age, comorbidities, occupation and living condition (congested or non-congested).Methods and findingsWe developed a compartmental disease model that incorporates key elements of the current pandemic including age-varying susceptibility to infection, age-varying clinical fraction, an active case-count dependent social distancing level, and time-varying infectivity (accounting for the emergence of more infectious virus strains). The CDC allocation strategy is compared to all other possibly optimal allocations that stagger vaccine roll-out in up to four phases (17.5 million strategies). The CDC allocation strategy performed well in all vaccination goals but never optimally. Under the developed model, the CDC allocation deviated from the optimal allocations by small amounts, with 0.19% more deaths, 4.0% more cases, 4.07% more infections, and 0.97% higher YLL, than the respective optimal strategies. The CDC decision to not prioritize the vaccination of individuals under the age of 16 was optimal, as was the prioritization of health-care workers and other essential workers over non-essential workers. Finally, a higher prioritization of individuals with comorbidities in all age groups improved outcomes compared to the CDC allocation.ConclusionThe developed approach can be used to inform the design of future vaccine allocation strategies in the United States, or adapted for use by other countries seeking to optimize the effectiveness of their vaccine allocation strategies.

Project description:In the last two years, the coronavirus disease 19 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a scientific and social challenge worldwide. Vaccines have been the most effective intervention for reducing virus transmission and disease severity. However, virus genetic variants are still circulating among vaccinated individuals with different symptomatology disease cases. Understanding the protective or disease associated mechanisms in vaccinated individuals is relevant to advance in vaccine development and implementation. To address this objective, serum protein profiles were characterized by quantitative proteomics and data analysis algorithms in four cohorts of vaccinated individuals uninfected and SARS-CoV-2 infected with asymptomatic, nonsevere and severe disease symptomatology. The results showed that immunoglobulins were the most overrepresented proteins in infected cohorts when compared to PCR-negative individuals. The immunoglobulin profile varied between different infected cohorts and correlated with protective or disease associated capacity. Overrepresented immunoglobulins in PCR-positive individuals correlated with protective response against SARS-CoV-2, other viruses, and thrombosis in asymptomatic cases. In nonsevere cases, correlates of protection against SARS-CoV-2 and HBV together with risk of myasthenia gravis and allergy and autoantibodies were observed. Patients with severe symptoms presented risk for allergy, chronic idiopathic thrombocytopenic purpura, and autoantibodies. The analysis of underrepresented immunoglobulins in PCR-positive compared to PCR-negative individuals identified vaccine-induced protective epitopes in various coronavirus proteins including the Spike receptor-binding domain RBD. Non-immunoglobulin proteins were associated with COVID-19 symptoms and biological processes. These results evidence host-associated differences in response to vaccination and the possibility of improving vaccine efficacy against SARS-CoV-2.

Project description:ObjectivesThe COVID-19 pandemic has had devastating worldwide impact but most prominent was its effect on marginalised, underserved and equity-deserving populations. Social media arose as an important platform from which health organisations could rapidly disseminate information to equity-deserving populations about COVID-19 risks and events, provide instructions on how to mitigate those risks, motivate compliance with health directives, address false information, provide the opportunity for engagement and immediate feedback. The objective of this scoping review was to synthesise the academic and grey literature on equity-informed social media risk communication strategies developed during the pandemic.DesignThe review followed the Arksey and O'Malley framework and focused on the research question: What are the promising principles, processes, and practices for producing equity-informed social media risk communications?Data sourcesCINAHL Complete, MEDLINE (OVID), Business Source Complete, EMBASE database OVID, Scopus and PubMed's curated COVID-19 literature hub: LitCovid, PsycINFO OVID were searched using terms related to access to health services, social media, risk communication, misinformation, community engagement, infectious disease, pandemics and marginalisation, supplemented by grey literature from relevant health organisations.Eligibility criteria for selecting studiesStudies were eligible if the population of interest was an equity-deserving population, the concept discussed was COVID-19 risk communication and the article was published in English between January 2019 and December 2022.Data extraction and synthesisCOVIDENCE facilitated screening and extraction. Charted data were thematically analysed following Braun and Clarke's phased process. Preliminary findings were collaboratively discussed with representatives from health agencies and community organisations focused on serving equity-deserving groups.Results12 studies were included. In terms of principles and process, studies emphasised the need to collaboratively create plans for message construction and targeted dissemination using a risk communication framework, capitalise on access to community resources and pre-established communication mediums and be considerate of population-specific needs and concerns. Practice entails careful consideration of communication mediums, language usage, communication frequency and evaluation.ConclusionThis scoping review provides valuable insights for health agencies and community organisations in developing principles, processes and practices to equitably communicate risk information through social media. Engagement with stakeholders further refined and confirmed the findings, offering insights for future crisis communication strategies.

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COVID-19 Vaccine Allocation: Modeling Health Outcomes and Equity Implications of Alternative Strategies.

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