Limited initial supply of SARS-CoV-2 vaccine raises the question of how to prioritize available doses. Here, we used a mathematical model to compare five age-stratified prioritization strategies. A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old. Use of individual-level serological tests to redirect doses to seronegative individuals improved the marginal impact of each dose while potentially reducing existing inequities in COVID-19 impact. While maximum impact prioritization strategies were broadly consistent across countries, transmission rates, vaccination rollout speeds, and estimates of naturally acquired immunity, this framework can be used to compare impacts of prioritization strategies across contexts.
There are two main approaches to vaccine prioritization: directly vaccinate those at highest risk for severe outcomes and protect them indirectly by vaccinating those who do the most transmitting. Model-based investigations of the tradeoffs between these strategies for influenza vaccination have led to recommendations that children be vaccinated due to their critical role in transmission and have shown that direct protection is superior when reproduction numbers are high but indirect protection is superior when transmission is low. Similar modeling for COVID-19 vaccination has found that the optimal balance between direct and indirect protection depends on both vaccine efficacy and supply, recommending direct vaccination of older adults for low-efficacy vaccines and for high-efficacy but supply-limited vaccines. Rather than comparing prioritization strategies, others have compared hypothetical vaccines, showing that even those with lower efficacy for direct protection may be more valuable if they also provide better indirect protection by blocking transmission. Prioritization of transmission-blocking vaccines can also be dynamically updated based on the current state of the epidemic, shifting prioritization to avoid decreasing marginal returns. These efforts to prioritize and optimize doses complement other work showing that, under different vaccine efficacy and durability of immunity, the economic and health benefits of COVID-19 vaccines will be large in the short and medium terms. The problem of vaccine prioritization also parallels the more general problem of optimal resource allocation to reduce transmission, e.g., with masks.
Vaccination rates vary by county, determined by local factors
COVID-19 has disproportionately affected certain underserved and high-risk populations, including people of color, those with underlying health conditions, and those who are socioeconomically disadvantaged. Ensuring access to COVID-19 vaccines for these communities can help address the disparate health effects of the virus and achieve herd immunity.
The Biden administration has identified vaccine equity as a priority, but states and local jurisdictions vary in how and the extent to which they prioritize equity. Given that vaccine roll-out in the U.S. is inherently local, understanding how vaccination rates vary at the local level is important for informing outreach efforts and addressing equity.
Earlier CDC analysis found that, as of early March, counties with high social vulnerability had lower vaccination rates than counties with low social vulnerability.
Source: Kaisesr Permanente Foundation
Dr. Anandi Gopal Joshi, the first Indian physician trained in the United States
Anandibai travelled to New York from Kolkata (Calcutta) by ship, chaperoned by two female English missionary acquaintances of the Thorborns. In New York, Theodicia Carpenter received her in June 1883. Anandibai wrote to the Woman’s Medical College of Pennsylvania in Philadelphia, asking to be admitted to their medical program, which was the second women’s medical […]