The Population-Wide Risk-Benefit Profile of Extending the Primary COVID-19 Vaccine Course Compared with an mRNA Booster Dose Program.

Tinevimbo Shiri,Marc Evans,William David Strain,Angharad R Morgan,Maaz Mussad,Carla A Talarico,Philip O Buck,Phil Mcewan

doi:10.3390/vaccines10020140

Abstract

The vaccination program is reducing the burden of COVID-19. However, recently, COVID-19 infections have been increasing across Europe, providing evidence that vaccine efficacy is waning. Consequently, booster doses are required to restore immunity levels. However, the relative risk–benefit ratio of boosters, compared to pursuing a primary course in the unvaccinated population, remains uncertain. In this study, a susceptible-exposed-infectious-recovered (SEIR) transmission model of SARS-CoV-2 was used to investigate the impact of COVID-19 vaccine waning on disease burden, the benefit of a booster vaccine program compared to targeting the unvaccinated population, and the population-wide risk–benefit profile of vaccination. Our data demonstrates that the rate of vaccine efficacy waning has a significant impact on COVID-19 hospitalisations with the greatest effect in populations with lower vaccination coverage. There was greater benefit associated with a booster vaccination strategy compared to targeting the unvaccinated population, once >50% of the population had received their primary vaccination course. The population benefits of vaccination (reduced hospitalisations, long-COVID and deaths) outweighed the risks of myocarditis/pericarditis by an order of magnitude. Vaccination is important in ending the COVID-19 pandemic sooner, and the reduction in hospitalisations, death and long-COVID associated with vaccination significantly outweigh any risks. Despite these obvious benefits some people are vaccine reluctant, and as such remain unvaccinated. However, when most of a population have been vaccinated, a focus on a booster vaccine strategy for this group is likely to offer greater value, than targeting the proportion of the population who choose to remain unvaccinated.

Highlights

Vaccination has played an important role in protecting against severe disease and death from COVID-19, as demonstrated in both clinical trials [1,2,3,4] and real-world settings [5,6,7,8,9]
The objective of this study is to evaluate the impact of COVID-19 vaccine efficacy waning on disease burden, and subsequently quantify the population-wide risk–benefit profile of COVID-19 vaccination
Our previously published Susceptible-Exposed-Infectious-Recovered (SEIR) transmission model of SARS-CoV-2 virus [34] was updated to capture the impact of immunity waning and booster dosing of those who had a primary series of COVID-19 vaccination (Figure 1)

Summary

Introduction

Vaccination has played an important role in protecting against severe disease and death from COVID-19, as demonstrated in both clinical trials [1,2,3,4] and real-world settings [5,6,7,8,9]. SARS-CoV-2 infection over time, as well as diminished antibody responses in those who are immunocompromised This resulted in the re-instigation of lockdowns in several wellvaccinated European countries including Austria and Germany. A number of recent studies examining vaccine effectiveness and duration of protection against mild and severe COVID-19 report an increasing proportion of breakthrough infections among the earliest vaccinated individuals [15,16,17], with the greatest numerical reduction in vaccine efficacy in older adults and those in a clinical risk group [18]

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