Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
International Decision Support Initiative, Center for Global Development, London, UK.
BMC Med. 2021 Dec 1;19(1):318. doi: 10.1186/s12916-021-02190-3.
How best to prioritise COVID-19 vaccination within and between countries has been a public health and an ethical challenge for decision-makers globally. We reviewed epidemiological and economic modelling evidence on population priority groups to minimise COVID-19 mortality, transmission, and morbidity outcomes.
We searched the National Institute of Health iSearch COVID-19 Portfolio (a database of peer-reviewed and pre-print articles), Econlit, the Centre for Economic Policy Research, and the National Bureau of Economic Research for mathematical modelling studies evaluating the impact of prioritising COVID-19 vaccination to population target groups. The first search was conducted on March 3, 2021, and an updated search on the LMIC literature was conducted from March 3, 2021, to September 24, 2021. We narratively synthesised the main study conclusions on prioritisation and the conditions under which the conclusions changed.
The initial search identified 1820 studies and 36 studies met the inclusion criteria. The updated search on LMIC literature identified 7 more studies. 43 studies in total were narratively synthesised. 74% of studies described outcomes in high-income countries (single and multi-country). We found that for countries seeking to minimise deaths, prioritising vaccination of senior adults was the optimal strategy and for countries seeking to minimise cases the young were prioritised. There were several exceptions to the main conclusion, notably that reductions in deaths could be increased if groups at high risk of both transmission and death could be further identified. Findings were also sensitive to the level of vaccine coverage.
The evidence supports WHO SAGE recommendations on COVID-19 vaccine prioritisation. There is, however, an evidence gap on optimal prioritisation for low- and middle-income countries, studies that included an economic evaluation, and studies that explore prioritisation strategies if the aim is to reduce overall health burden including morbidity.
如何在国家内部和国家之间为 COVID-19 疫苗接种制定最佳优先级一直是全球决策者在公共卫生和伦理方面面临的挑战。我们回顾了有关人群优先群体的流行病学和经济建模证据，以最大程度地降低 COVID-19 死亡率、传播和发病结果。
我们在 National Institute of Health iSearch COVID-19 Portfolio（同行评审和预印本文章数据库）、Econlit、Centre for Economic Policy Research 和 National Bureau of Economic Research 中搜索了评估将 COVID-19 疫苗接种优先用于人群目标群体对人口的影响的数学建模研究。第一次搜索于 2021 年 3 月 3 日进行，对 LMIC 文献的更新搜索于 2021 年 3 月 3 日至 2021 年 9 月 24 日进行。我们对优先排序的主要研究结论和结论变化的条件进行了叙述性综合。
初步搜索确定了 1820 项研究，其中 36 项符合纳入标准。对 LMIC 文献的更新搜索确定了另外 7 项研究。总共叙述性综合了 43 项研究。74%的研究描述了高收入国家（单一和多国家）的结果。我们发现，对于试图降低死亡率的国家来说，优先为老年人接种疫苗是最佳策略，而对于试图降低病例数的国家来说，年轻人则是优先考虑的对象。除了主要结论之外，还有一些例外情况，即如果能够进一步确定既具有传播风险又具有死亡风险的高风险人群，则可以增加死亡人数的减少。研究结果还对疫苗接种覆盖率水平敏感。
证据支持世界卫生组织 SAGE 关于 COVID-19 疫苗接种优先级的建议。然而，对于中低收入国家、包括经济评估的研究以及如果目标是降低包括发病率在内的整体健康负担的优先排序策略研究，仍存在证据空白。
