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.
American debt to exceed GDP in 2021
The United States is projected to hold about $21 trillion in debt in 2021, and that number is expected to increase to $32 trillion by 2030. A $1.9 trillion stimulus bill represents a fraction of that increase, although White House officials have also discussed trying to approve a multitrillion-dollar infrastructure package later this year. The CBO projections also assume the expiration of numerous provisions of the 2017 GOP tax law aimed at the lower and middle class by the middle of this decade.
Marc Goldwein, senior vice president at the Committee for a Responsible Federal Budget, which pushes for deficit reduction, said lawmakers face a long-term challenge in getting spending and deficit levels to balance. That is not something that hinges on the precise size of Biden’s stimulus package, Goldwein said.
“Even without the $1.9 trillion [stimulus], we will be at record-high debt levels” in a few years, he said. “Realistically, it’s going to come much sooner than that.”
Source: Washington Post