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Within-country age-based prioritisation, global allocation, and public health impact of a vaccine against SARS-CoV-2: A mathematical modelling analysis.
Vaccine. 2021 05 21; 39(22):2995-3006.V

Abstract

The worldwide endeavour to develop safe and effective COVID-19 vaccines has been extraordinary, and vaccination is now underway in many countries. However, the doses available in 2021 are likely to be limited. We extend a mathematical model of SARS-CoV-2 transmission across different country settings to evaluate the public health impact of potential vaccines using WHO-developed target product profiles. We identify optimal vaccine allocation strategies within- and between-countries to maximise averted deaths under constraints on dose supply. We find that the health impact of SARS-CoV-2 vaccination depends on the cumulative population-level infection incidence when vaccination begins, the duration of natural immunity, the trajectory of the epidemic prior to vaccination, and the level of healthcare available to effectively treat those with disease. Within a country we find that for a limited supply (doses for < 20% of the population) the optimal strategy is to target the elderly. However, with a larger supply, if vaccination can occur while other interventions are maintained, the optimal strategy switches to targeting key transmitters to indirectly protect the vulnerable. As supply increases, vaccines that reduce or block infection have a greater impact than those that prevent disease alone due to the indirect protection provided to high-risk groups. Given a 2 billion global dose supply in 2021, we find that a strategy in which doses are allocated to countries proportional to population size is close to optimal in averting deaths and aligns with the ethical principles agreed in pandemic preparedness planning.

Authors+Show Affiliations

MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: a.hogan@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: p.winskill@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: o.watson15@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: patrick.walker06@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: charles.whittaker16@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom. Electronic address: m.baguelin@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: n.brazeau@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: gc1610@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: k.gaythorpe@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: arran.hamlet14@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: e.knock@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: d.laydon@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: j.lees@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: a.lochen17@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: r.verity@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: l.whittles@imperial.ac.uk.PATH, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC 20001, USA. Electronic address: fmuhib@path.org.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: k.hauck@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: neil.ferguson@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, United Kingdom. Electronic address: a.ghani@imperial.ac.uk.

Pub Type(s)

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

Language

eng

PubMed ID

33933313

Citation

Hogan, Alexandra B., et al. "Within-country Age-based Prioritisation, Global Allocation, and Public Health Impact of a Vaccine Against SARS-CoV-2: a Mathematical Modelling Analysis." Vaccine, vol. 39, no. 22, 2021, pp. 2995-3006.
Hogan AB, Winskill P, Watson OJ, et al. Within-country age-based prioritisation, global allocation, and public health impact of a vaccine against SARS-CoV-2: A mathematical modelling analysis. Vaccine. 2021;39(22):2995-3006.
Hogan, A. B., Winskill, P., Watson, O. J., Walker, P. G. T., Whittaker, C., Baguelin, M., Brazeau, N. F., Charles, G. D., Gaythorpe, K. A. M., Hamlet, A., Knock, E., Laydon, D. J., Lees, J. A., Løchen, A., Verity, R., Whittles, L. K., Muhib, F., Hauck, K., Ferguson, N. M., & Ghani, A. C. (2021). Within-country age-based prioritisation, global allocation, and public health impact of a vaccine against SARS-CoV-2: A mathematical modelling analysis. Vaccine, 39(22), 2995-3006. https://doi.org/10.1016/j.vaccine.2021.04.002
Hogan AB, et al. Within-country Age-based Prioritisation, Global Allocation, and Public Health Impact of a Vaccine Against SARS-CoV-2: a Mathematical Modelling Analysis. Vaccine. 2021 05 21;39(22):2995-3006. PubMed PMID: 33933313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Within-country age-based prioritisation, global allocation, and public health impact of a vaccine against SARS-CoV-2: A mathematical modelling analysis. AU - Hogan,Alexandra B, AU - Winskill,Peter, AU - Watson,Oliver J, AU - Walker,Patrick G T, AU - Whittaker,Charles, AU - Baguelin,Marc, AU - Brazeau,Nicholas F, AU - Charles,Giovanni D, AU - Gaythorpe,Katy A M, AU - Hamlet,Arran, AU - Knock,Edward, AU - Laydon,Daniel J, AU - Lees,John A, AU - Løchen,Alessandra, AU - Verity,Robert, AU - Whittles,Lilith K, AU - Muhib,Farzana, AU - Hauck,Katharina, AU - Ferguson,Neil M, AU - Ghani,Azra C, Y1 - 2021/04/08/ PY - 2021/03/29/received PY - 2021/04/01/accepted PY - 2021/5/3/pubmed PY - 2021/5/28/medline PY - 2021/5/2/entrez KW - COVID-19 KW - Mathematical model KW - Optimisation KW - SARS-CoV-2 KW - Vaccination model SP - 2995 EP - 3006 JF - Vaccine JO - Vaccine VL - 39 IS - 22 N2 - The worldwide endeavour to develop safe and effective COVID-19 vaccines has been extraordinary, and vaccination is now underway in many countries. However, the doses available in 2021 are likely to be limited. We extend a mathematical model of SARS-CoV-2 transmission across different country settings to evaluate the public health impact of potential vaccines using WHO-developed target product profiles. We identify optimal vaccine allocation strategies within- and between-countries to maximise averted deaths under constraints on dose supply. We find that the health impact of SARS-CoV-2 vaccination depends on the cumulative population-level infection incidence when vaccination begins, the duration of natural immunity, the trajectory of the epidemic prior to vaccination, and the level of healthcare available to effectively treat those with disease. Within a country we find that for a limited supply (doses for < 20% of the population) the optimal strategy is to target the elderly. However, with a larger supply, if vaccination can occur while other interventions are maintained, the optimal strategy switches to targeting key transmitters to indirectly protect the vulnerable. As supply increases, vaccines that reduce or block infection have a greater impact than those that prevent disease alone due to the indirect protection provided to high-risk groups. Given a 2 billion global dose supply in 2021, we find that a strategy in which doses are allocated to countries proportional to population size is close to optimal in averting deaths and aligns with the ethical principles agreed in pandemic preparedness planning. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/33933313/Within_country_age_based_prioritisation_global_allocation_and_public_health_impact_of_a_vaccine_against_SARS_CoV_2:_A_mathematical_modelling_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(21)00427-8 DB - PRIME DP - Unbound Medicine ER -