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India's pragmatic vaccination strategy against COVID-19: a mathematical modelling-based analysis.
BMJ Open. 2021 07 02; 11(7):e048874.BO

Abstract

OBJECTIVES

To investigate the impact of targeted vaccination strategies on morbidity and mortality due to COVID-19, as well as on the incidence of SARS-CoV-2, in India.

DESIGN

Mathematical modelling.

SETTINGS

Indian epidemic of COVID-19 and vulnerable population.

DATA SOURCES

Country-specific and age-segregated pattern of social contact, case fatality rate and demographic data obtained from peer-reviewed literature and public domain.

MODEL

An age-structured dynamical model describing SARS-CoV-2 transmission in India incorporating uncertainty in natural history parameters was constructed.

INTERVENTIONS

Comparison of different vaccine strategies by targeting priority groups such as keyworkers including healthcare professionals, individuals with comorbidities (24-60 years old) and all above 60.

MAIN OUTCOME MEASURES

Incidence reduction and averted deaths in different scenarios, assuming that the current restrictions are fully lifted as vaccination is implemented.

RESULTS

The priority groups together account for about 18% of India's population. An infection-preventing vaccine with 60% efficacy covering all these groups would reduce peak symptomatic incidence by 20.6% (95% uncertainty intervals (UI) 16.7-25.4) and cumulative mortality by 29.7% (95% CrI 25.8-33.8). A similar vaccine with ability to prevent symptoms (but not infection) will reduce peak incidence of symptomatic cases by 10.4% (95% CrI 8.4-13.0) and cumulative mortality by 32.9% (95% CrI 28.6-37.3). In the event of insufficient vaccine supply to cover all priority groups, model projections suggest that after keyworkers, vaccine strategy should prioritise all who are >60 and subsequently individuals with comorbidities. In settings with weakest transmission, such as sparsely populated rural areas, those with comorbidities should be prioritised after keyworkers.

CONCLUSIONS

An appropriately targeted vaccination strategy would witness substantial mitigation of impact of COVID-19 in a country like India with wide heterogeneity. 'Smart vaccination', based on public health considerations, rather than mass vaccination, appears prudent.

Authors+Show Affiliations

Division of Epidemiology and Communicable Diseases (Clinical Studies, Projection & Policy Unit), Indian Council of Medical Research, New Delhi, India.MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.Indian Council of Medical Research, New Delhi, India.Division of Epidemiology and Communicable Diseases (Clinical Studies, Projection & Policy Unit), Indian Council of Medical Research, New Delhi, India pandasamiran@gmail.com. National AIDS Research Institute Indian Council of Medical Research, Pune, Maharashtra, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34215611

Citation

Mandal, Sandip, et al. "India's Pragmatic Vaccination Strategy Against COVID-19: a Mathematical Modelling-based Analysis." BMJ Open, vol. 11, no. 7, 2021, pp. e048874.
Mandal S, Arinaminpathy N, Bhargava B, et al. India's pragmatic vaccination strategy against COVID-19: a mathematical modelling-based analysis. BMJ Open. 2021;11(7):e048874.
Mandal, S., Arinaminpathy, N., Bhargava, B., & Panda, S. (2021). India's pragmatic vaccination strategy against COVID-19: a mathematical modelling-based analysis. BMJ Open, 11(7), e048874. https://doi.org/10.1136/bmjopen-2021-048874
Mandal S, et al. India's Pragmatic Vaccination Strategy Against COVID-19: a Mathematical Modelling-based Analysis. BMJ Open. 2021 07 2;11(7):e048874. PubMed PMID: 34215611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - India's pragmatic vaccination strategy against COVID-19: a mathematical modelling-based analysis. AU - Mandal,Sandip, AU - Arinaminpathy,Nimalan, AU - Bhargava,Balram, AU - Panda,Samiran, Y1 - 2021/07/02/ PY - 2021/7/3/entrez PY - 2021/7/4/pubmed PY - 2021/7/9/medline KW - COVID-19 KW - epidemiology KW - health policy KW - public health SP - e048874 EP - e048874 JF - BMJ open JO - BMJ Open VL - 11 IS - 7 N2 - OBJECTIVES: To investigate the impact of targeted vaccination strategies on morbidity and mortality due to COVID-19, as well as on the incidence of SARS-CoV-2, in India. DESIGN: Mathematical modelling. SETTINGS: Indian epidemic of COVID-19 and vulnerable population. DATA SOURCES: Country-specific and age-segregated pattern of social contact, case fatality rate and demographic data obtained from peer-reviewed literature and public domain. MODEL: An age-structured dynamical model describing SARS-CoV-2 transmission in India incorporating uncertainty in natural history parameters was constructed. INTERVENTIONS: Comparison of different vaccine strategies by targeting priority groups such as keyworkers including healthcare professionals, individuals with comorbidities (24-60 years old) and all above 60. MAIN OUTCOME MEASURES: Incidence reduction and averted deaths in different scenarios, assuming that the current restrictions are fully lifted as vaccination is implemented. RESULTS: The priority groups together account for about 18% of India's population. An infection-preventing vaccine with 60% efficacy covering all these groups would reduce peak symptomatic incidence by 20.6% (95% uncertainty intervals (UI) 16.7-25.4) and cumulative mortality by 29.7% (95% CrI 25.8-33.8). A similar vaccine with ability to prevent symptoms (but not infection) will reduce peak incidence of symptomatic cases by 10.4% (95% CrI 8.4-13.0) and cumulative mortality by 32.9% (95% CrI 28.6-37.3). In the event of insufficient vaccine supply to cover all priority groups, model projections suggest that after keyworkers, vaccine strategy should prioritise all who are >60 and subsequently individuals with comorbidities. In settings with weakest transmission, such as sparsely populated rural areas, those with comorbidities should be prioritised after keyworkers. CONCLUSIONS: An appropriately targeted vaccination strategy would witness substantial mitigation of impact of COVID-19 in a country like India with wide heterogeneity. 'Smart vaccination', based on public health considerations, rather than mass vaccination, appears prudent. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/34215611/India's_pragmatic_vaccination_strategy_against_COVID_19:_a_mathematical_modelling_based_analysis_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=34215611 DB - PRIME DP - Unbound Medicine ER -