Who should be prioritized for COVID-19 vaccination in China? A descriptive study

Abstract

Background All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. Methods On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. Results Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. Conclusions The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.

Despite vaccination, China needs non-pharmaceutical interventions to prevent widespread outbreaks of COVID-19 in 2021

“…Each age group was further split into two subgroups: individuals with or without underlying conditions, where the former was considered to be associated with an increased risk of severe outcome of COVID-19 (ref. 14 ).…”

“…In the model, we account for heterogeneous mixing patterns by age 13 and progressive vaccine deployment among different population segments based on a priority scheme (essential workers, older adults, individuals with underlying conditions, etc.) 14 . Further, we overlay a disease burden model on the transmission model to estimate the number of symptomatic cases, hospitalizations, intensive care unit (ICU) admissions and deaths under different vaccination scenarios and based on empirical data 15 – 20 .…”

“…We considered a baseline vaccination scenario where: (1) vaccination starts 15 days after an outbreak triggered by 40 breakthrough imported SARS-CoV-2 infections; (2) vaccine efficacy (VE) against SARS-CoV-2 infections for a two-dose schedule (with a 21-day interval) is set at 80% 21 ; (3) vaccination coverage is capped at 70% across all ages 14 ; (4) 6 million doses are administered daily (4 per 1,000 individuals, informed by the ongoing COVID-19 vaccination programme 6 , and estimates of vaccine supply till 2021 in China 22 – 26 ); (5) the first priority target consists of older adults and individuals with underlying conditions (descriptions in detail shown in Supplementary Table 2 ); (6) there is no prior population immunity from natural infection, which aligns with the situation in most of China, where there has been little circulation of SARS-CoV-2 as of May 2021 (ref. 3 ); (7) we assume an initial reproductive number R t = 2.5 at the start of the outbreak 27 – 32 , in the absence of NPIs and vaccination; (8) children under 15 years of age were considered to have a lower susceptibility to SARS-CoV-2 infection as compared with adults (that is, individuals aged 15–64 years), while individuals aged 65+ years had the highest susceptibility to infection (Supplementary Table 1 ) 33 , 34 ; (9) we let the model run for 2 years.…”

Gastrointestinal cancers, ACE-2/TMPRSS2 expression and susceptibility to COVID-19

“…Albeit several commercial COVID-19 vaccines are currently available, achieving herd immunity through vaccination is still a debated endpoint. With that in mind, several vaccination guidelines have been developed to prioritize sub-groups vulnerable to COVID-19 [ 4 , 5 ]. Arranging these guidelines require deep knowledge of the COVID-19 pathophysiology, which is continuously evolving.…”

Optimal control of the spatial allocation of COVID-19 vaccines: Italy as a case study

“…The problem of vaccine allocation is of primary importance for public-health officials, epidemiologists, and economists [10,11]. Roll-out strategies are conventionally based on the prioritization of individuals at risk, such as health workers and elderly people [12][13][14][15]. However, the heterogeneous ways in which different regions may be affected by each successive wave raise questions about spatial prioritization strategies.…”