Abstract
BackgroundAll 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.MethodsOn 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.ResultsEssential 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.ConclusionsThe 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.
Highlights
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
We assumed that the capacity of COVID-19 vaccination services could be scaled up to 10 million doses administered per day in the baseline analysis
We estimated that in mainland China there are 10.7 million healthcare workers, 4.7 million people working in law enforcement agencies and security personnel, 0.4 million personnel in nursing home and social welfare institutes, 4.5 million community workers, 27.3 million workers in the energy, food, and transportation sectors, and 2.2 million persons studying/ working abroad
Summary
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. Setting priorities for target populations to be vaccinated and optimizing resources within and between countries entails difficult choices This is critical for a successful global pandemic vaccination program, and this needs to be addressed urgently. The WHO Strategic Advisory Group of Experts on Immunization (SAGE) Values Framework for The Allocation and Prioritization of COVID-19 Vaccination offers core principles for vaccine distribution [5]. These guidelines need to be further specified and tailored to each county, taking into local contexts including but not limited to the intensity of epidemic, the objectives of pandemic responses, the vaccine supply, and the size of the population eligible for vaccination
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