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Vaccination and non-pharmaceutical interventions for COVID-19: a mathematical modelling study.
Lancet Infect Dis. 2021 06; 21(6):793-802.LI

Abstract

BACKGROUND

The dynamics of vaccination against SARS-CoV-2 are complicated by age-dependent factors, changing levels of infection, and the relaxation of non-pharmaceutical interventions (NPIs) as the perceived risk declines, necessitating the use of mathematical models. Our aims were to use epidemiological data from the UK together with estimates of vaccine efficacy to predict the possible long-term dynamics of SARS-CoV-2 under the planned vaccine rollout.

METHODS

In this study, we used a mathematical model structured by age and UK region, fitted to a range of epidemiological data in the UK, which incorporated the planned rollout of a two-dose vaccination programme (doses 12 weeks apart, protection onset 14 days after vaccination). We assumed default vaccine uptake of 95% in those aged 80 years and older, 85% in those aged 50-79 years, and 75% in those aged 18-49 years, and then varied uptake optimistically and pessimistically. Vaccine efficacy against symptomatic disease was assumed to be 88% on the basis of Pfizer-BioNTech and Oxford-AstraZeneca vaccines being administered in the UK, and protection against infection was varied from 0% to 85%. We considered the combined interaction of the UK vaccination programme with multiple potential future relaxations (or removals) of NPIs, to predict the reproduction number (R) and pattern of daily deaths and hospital admissions due to COVID-19 from January, 2021, to January, 2024.

FINDINGS

We estimate that vaccination alone is insufficient to contain the outbreak. In the absence of NPIs, even with our most optimistic assumption that the vaccine will prevent 85% of infections, we estimate R to be 1·58 (95% credible intervals [CI] 1·36-1·84) once all eligible adults have been offered both doses of the vaccine. Under the default uptake scenario, removal of all NPIs once the vaccination programme is complete is predicted to lead to 21 400 deaths (95% CI 1400-55 100) due to COVID-19 for a vaccine that prevents 85% of infections, although this number increases to 96 700 deaths (51 800-173 200) if the vaccine only prevents 60% of infections. Although vaccination substantially reduces total deaths, it only provides partial protection for the individual; we estimate that, for the default uptake scenario and 60% protection against infection, 48·3% (95% CI 48·1-48·5) and 16·0% (15·7-16·3) of deaths will be in individuals who have received one or two doses of the vaccine, respectively.

INTERPRETATION

For all vaccination scenarios we investigated, our predictions highlight the risks associated with early or rapid relaxation of NPIs. Although novel vaccines against SARS-CoV-2 offer a potential exit strategy for the pandemic, success is highly contingent on the precise vaccine properties and population uptake, both of which need to be carefully monitored.

FUNDING

National Institute for Health Research, Medical Research Council, and UK Research and Innovation.

Authors+Show Affiliations

Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute, and School of Life Sciences, University of Warwick, Coventry, UK.Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute, and School of Life Sciences, University of Warwick, Coventry, UK.Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute, and School of Life Sciences, University of Warwick, Coventry, UK.Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute, and School of Life Sciences, University of Warwick, Coventry, UK.Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute, and School of Life Sciences, University of Warwick, Coventry, UK. Electronic address: m.j.keeling@warwick.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33743847

Citation

Moore, Sam, et al. "Vaccination and Non-pharmaceutical Interventions for COVID-19: a Mathematical Modelling Study." The Lancet. Infectious Diseases, vol. 21, no. 6, 2021, pp. 793-802.
Moore S, Hill EM, Tildesley MJ, et al. Vaccination and non-pharmaceutical interventions for COVID-19: a mathematical modelling study. Lancet Infect Dis. 2021;21(6):793-802.
Moore, S., Hill, E. M., Tildesley, M. J., Dyson, L., & Keeling, M. J. (2021). Vaccination and non-pharmaceutical interventions for COVID-19: a mathematical modelling study. The Lancet. Infectious Diseases, 21(6), 793-802. https://doi.org/10.1016/S1473-3099(21)00143-2
Moore S, et al. Vaccination and Non-pharmaceutical Interventions for COVID-19: a Mathematical Modelling Study. Lancet Infect Dis. 2021;21(6):793-802. PubMed PMID: 33743847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vaccination and non-pharmaceutical interventions for COVID-19: a mathematical modelling study. AU - Moore,Sam, AU - Hill,Edward M, AU - Tildesley,Michael J, AU - Dyson,Louise, AU - Keeling,Matt J, Y1 - 2021/03/18/ PY - 2020/12/21/received PY - 2021/02/28/revised PY - 2021/03/01/accepted PY - 2021/3/22/pubmed PY - 2021/7/2/medline PY - 2021/3/21/entrez SP - 793 EP - 802 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 21 IS - 6 N2 - BACKGROUND: The dynamics of vaccination against SARS-CoV-2 are complicated by age-dependent factors, changing levels of infection, and the relaxation of non-pharmaceutical interventions (NPIs) as the perceived risk declines, necessitating the use of mathematical models. Our aims were to use epidemiological data from the UK together with estimates of vaccine efficacy to predict the possible long-term dynamics of SARS-CoV-2 under the planned vaccine rollout. METHODS: In this study, we used a mathematical model structured by age and UK region, fitted to a range of epidemiological data in the UK, which incorporated the planned rollout of a two-dose vaccination programme (doses 12 weeks apart, protection onset 14 days after vaccination). We assumed default vaccine uptake of 95% in those aged 80 years and older, 85% in those aged 50-79 years, and 75% in those aged 18-49 years, and then varied uptake optimistically and pessimistically. Vaccine efficacy against symptomatic disease was assumed to be 88% on the basis of Pfizer-BioNTech and Oxford-AstraZeneca vaccines being administered in the UK, and protection against infection was varied from 0% to 85%. We considered the combined interaction of the UK vaccination programme with multiple potential future relaxations (or removals) of NPIs, to predict the reproduction number (R) and pattern of daily deaths and hospital admissions due to COVID-19 from January, 2021, to January, 2024. FINDINGS: We estimate that vaccination alone is insufficient to contain the outbreak. In the absence of NPIs, even with our most optimistic assumption that the vaccine will prevent 85% of infections, we estimate R to be 1·58 (95% credible intervals [CI] 1·36-1·84) once all eligible adults have been offered both doses of the vaccine. Under the default uptake scenario, removal of all NPIs once the vaccination programme is complete is predicted to lead to 21 400 deaths (95% CI 1400-55 100) due to COVID-19 for a vaccine that prevents 85% of infections, although this number increases to 96 700 deaths (51 800-173 200) if the vaccine only prevents 60% of infections. Although vaccination substantially reduces total deaths, it only provides partial protection for the individual; we estimate that, for the default uptake scenario and 60% protection against infection, 48·3% (95% CI 48·1-48·5) and 16·0% (15·7-16·3) of deaths will be in individuals who have received one or two doses of the vaccine, respectively. INTERPRETATION: For all vaccination scenarios we investigated, our predictions highlight the risks associated with early or rapid relaxation of NPIs. Although novel vaccines against SARS-CoV-2 offer a potential exit strategy for the pandemic, success is highly contingent on the precise vaccine properties and population uptake, both of which need to be carefully monitored. FUNDING: National Institute for Health Research, Medical Research Council, and UK Research and Innovation. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/33743847/Vaccination_and_non_pharmaceutical_interventions_for_COVID_19:_a_mathematical_modelling_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-3099(21)00143-2 DB - PRIME DP - Unbound Medicine ER -