Objective The objective of this study was to implement a model-based approach to identify the optimal allocation of a coronavirus disease 2019 (COVID-19) vaccine in the province of Alberta, Canada. Methods We developed an epidemiologic model to evaluate allocation strategies defined by age and risk target groups, coverage, effectiveness and cost of vaccine. The model simulated hypothetical immunisation scenarios within a dynamic context, capturing concurrent public health strategies and population behavioural changes. Results In a scenario with 80% vaccine effectiveness, 40% population coverage and prioritisation of those over the age of 60 years at high risk of poor outcomes, active cases are reduced by 17% and net monetary benefit increased by $263 million dollars, relative to no vaccine. Concurrent implementation of policies such as school closure and senior contact reductions have similar impacts on incremental net monetary benefit ($352 vs $292 million, respectively) when there is no prioritisation given to any age or risk group. When older age groups are given priority, the relative benefit of school closures is much larger ($214 vs $118 million). Results demonstrate that the rank ordering of different prioritisation options varies by prioritisation criteria, vaccine effectiveness and coverage, and concurrently implemented policies. Conclusions Our results have three implications: (i) optimal vaccine allocation will depend on the public health policies in place at the time of allocation and the impact of those policies on population behaviour; (ii) outcomes of vaccine allocation policies can be greatly supported with interventions targeting contact reduction in critical sub-populations; and (iii) identification of the optimal strategy depends on which outcomes are prioritised. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01037-2.
Coronavirus disease 2019 (COVID-19) is a severe, novel virus that has spread globally. The implementation of a combination of public health interventions is required to reduce viral spread and avoid overwhelming acute care systems. Once available, an effective vaccination will further mitigate the impact of the COVID-19 pandemic. However, decision makers will initially need to prioritise access to limited vaccine stockpiles as these will be insufficient to vaccine the whole population. The aim of this study is to identify optimal vaccine allocation strategies defined by age and risk target groups, coverage, effectiveness, and cost of vaccine, within a dynamic context where other public health responses and population behaviour change. In this study we use an epidemiological model of COVID-19 that has been enhanced to produce expected costs and Quality Adjusted Life Year results as well as total cases, hospitalisations, deaths, and net monetary benefit. We use the model to simulate hypothetical scenarios where vaccine is allocated beginning on October 15, 2020 with vaccine assumptions ranging from moderately optimistic to worst-case scenario. Net monetary benefit is used as the objective for optimisation. In a scenario with a sterilizing vaccine that is 80% effective, a stockpile sufficient for 40% population coverage, and prioritisation of those over the age of 60 at high risk of poor outcomes, active cases are reduced by 29.2% and net monetary benefit increased by $297 million dollars, relative to an identical scenario with no vaccine. The relative impact of prioritisation strategies varies greatly depending on concurrent public health interventions, for example, polices such as school closures and senior contact reductions have similar impacts on incremental net monetary benefit when there is no prioritisation given to any age or risk group (147 vs. 120 million, respectively), but when older and high risk groups are given priority, the benefit of school closures is much larger than reducing contacts for seniors (iNB 122 vs. 79 million, respectively). Results demonstrated that rank ordering of different prioritisation options varied greatly by prioritisation criteria, with different vaccine effectiveness and coverage, and by concurrently implemented policies. The results of this paper have three key policy implications: (i) that optimal vaccine allocation will depend on the public health policies, and human behaviours in place at the time of allocation; (ii) the outcomes of vaccine allocation policies can be greatly supported with interventions targeting contact reduction in critical sub-populations; and (iii) the identification of the optimal strategy depends on which outcomes are prioritised.
Radiographic reporting in adolescent idiopathic scoliosis:Is there a discrepancy comparing radiologists' reports and surgeons' assessments? Karamjot Sidhu,
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