Who should be prioritised for COVID-19 vaccination?

ABSTRACT

The development of COVID-19 vaccines is occurring at a rapid pace, with the potential for a vaccine to be available within 6 months. So who should be prioritized for vaccination when in the first instance, there will be insufficient supply to meet demand? There is no doubt that health-care workers in all settings should be vaccinated first, but who comes next will be a complex decision based on local epidemiology, societal values, and the ability of the vaccines to prevent both severe disease and to reduce transmission thereby eliciting herd protection. The decision on who to vaccinate should be equitable, highly contextualized, and based on the property of each vaccine. In some settings, the elderly may be prioritized, in others, it may be the population most likely to get infected and responsible for community spread. To support decision-making on who to be prioritized for vaccination requires urgent additional research on the epidemiology of COVID-19; preexisting immunity and who is responsible for transmission in a variety of settings; the safety, immunogenicity, and efficacy of COVID-19 vaccines in children and pregnant women; and determining whether COVID-19 vaccines prevent asymptomatic infection and transmission.

Keywords:

• COVID-19 vaccines
• high-risk
• epidemiology
• transmission
• vaccine development
• clinical trials

Disclosure of potential conflicts of interest

Fiona Russell receives grant funding from the Australian National Health and Medical Research Council, The Wellcome Trust, the World Health Organization, the Bill & Melinda Gates Foundation and the Australian Department of Foreign Affairs and Trade. In the past, she has received funds from Gavi, the Vaccine Alliance.

Brian Greenwood receives grant funding from the UK Joint Global Health Trials (The Department of Health and Social Care, the Department for International Development, the Global Challenges Research Fund, the Medical Research Council and the Wellcome Trust) programme and from PATH. In recent years he has also received funding from the Bill & Melinda Gates Foundation and from The Welcome Trust.

Acknowledgments

We wish to thank Rita Reyburn for assistance with formatting the manuscript.

Additional information

Funding

Fiona Russell’s personal support comes from an Australian National Health and Medical Research Council Investigator grant and The University of Melbourne. Brian Greenwood’s personal support comes from the London School of Hygiene & Tropical Medicine;Australian National Health and Medical Research Council;