Department of Population Health, New York University Grossman School of Medicine, 227 E 30th Street, NY, 10016, New York, USA.
BMC Public Health. 2023 Jan 26;23(1):174. doi: 10.1186/s12889-022-14846-7.
Prioritization of higher-risk people for COVID-19 vaccination could prevent more deaths, but could slow vaccination speed. We used mathematical modeling to examine the trade-off between vaccination speed and prioritization for individuals age 65+ and essential workers.
We used a stochastic, discrete-time susceptible-exposed-infected-recovered (SEIR) model with age- and comorbidity-adjusted COVID-19 outcomes (infections, hospitalizations, and deaths). The model was calibrated to COVID-19 hospitalizations, ICU census, and deaths in NYC. We assumed 10,000 vaccinations per day, initially restricted to healthcare workers and nursing home populations, and subsequently expanded to other populations at alternative times (4, 5, or 6 weeks after vaccine launch) and speeds (20,000, 50,000, 100,000, or 150,000 vaccinations per day), as well as prioritization options (+/- prioritization of people age 65+ and essential workers). In sensitivity analyses, we examined the effect of a SARS-COV-2 variant with greater transmissibility.
To be beneficial, prioritization must not create a bottleneck that decreases vaccination speed by > 50% without a more transmissible variant, or by > 33% with the emergence of the more transmissible variant. More specifically, prioritizing people age 65+ and essential workers increased the number of lives saved per vaccine dose delivered: 3000 deaths could be averted by delivering 83,000 vaccinations per day without prioritization or 50,000 vaccinations per day with prioritization. Other tradeoffs involve vaccination speed and timing. Compared to the slowest-examined vaccination speed of 20,000 vaccinations per day, achieving the fastest-examined vaccination speed of 150,000 vaccinations per day would avert additional 313,700 (28.6%) infections and 1693 (24.1%) deaths. Emergence of a more transmissible variant would double COVID-19 infections, hospitalizations, and deaths over the first 6 months of vaccination. The fastest-examined vaccination speed could only offset the harm of the more transmissible variant if achieved within 5 weeks of vaccine launch.
Faster vaccination speed with sooner vaccination expansion would save more lives. Prioritization of COVID-19 vaccines to higher-risk populations would be more beneficial only if it does not create an excessive vaccine delivery bottleneck.
为 COVID-19 疫苗接种的高风险人群进行优先排序可以预防更多的死亡，但可能会减缓疫苗接种速度。我们使用数学模型来研究为 65 岁以上人群和基本工作人员进行疫苗接种的优先排序与疫苗接种速度之间的权衡。
我们使用了一个具有年龄和合并症调整的 COVID-19 结果（感染、住院和死亡）的随机、离散时间易感性-暴露-感染-恢复（SEIR）模型。该模型根据纽约市的 COVID-19 住院、重症监护病房人数和死亡人数进行了校准。我们假设每天接种 10000 剂疫苗，最初仅限于医护人员和养老院人群，随后在不同时间（疫苗推出后 4、5 或 6 周）和不同速度（每天 20000、50000、100000 或 150000 剂疫苗）扩大到其他人群，并进行了优先排序选项（是否优先考虑 65 岁以上人群和基本工作人员）。在敏感性分析中，我们研究了一种具有更高传染性的 SARS-COV-2 变体的影响。
要具有益处，优先排序不得在没有更具传染性的变体的情况下，将疫苗接种速度降低超过 50%，或者在出现更具传染性的变体的情况下降低超过 33%。更具体地说，优先考虑 65 岁以上人群和基本工作人员可以增加每接种一剂疫苗所挽救的生命数量：不进行优先排序每天可接种 83000 剂疫苗，或每天接种 50000 剂疫苗可避免 3000 人死亡。其他权衡涉及疫苗接种速度和时间。与我们研究的最慢接种速度 20000 剂疫苗相比，实现最快的接种速度 150000 剂疫苗每天可额外避免 313700（28.6%）感染和 1693（24.1%）死亡。更具传染性变体的出现将使 COVID-19 在接种疫苗的前 6 个月内的感染、住院和死亡人数增加一倍。只有在疫苗推出后 5 周内达到最快的接种速度，才能抵消更具传染性变体的危害。
更快的疫苗接种速度和更早的疫苗接种推广将挽救更多生命。只有在不造成疫苗接种过度瓶颈的情况下，为高风险人群接种 COVID-19 疫苗进行优先排序才会更有益。
