Covid-19 vaccine prioritisation | Data Futures Exchange

COVID-19 Vaccine Prioritisation: Protecting the Most Vulnerable

Published on 10 May 2022

In most countries, groups at higher exposure or clinical risk were prioritised to first receive the COVID-19 vaccine^[1]. A cursory review of COVID-19 vaccine rollout across income groups, however, suggests that low- and lower-middle income countries may have not been able to provide significant coverage to protect the most clinically vulnerable groups before broadening vaccine eligibility to every adult. While the duration between the first vaccine dose and the expansion of vaccine eligibility to all has been on par between income groups, on average (median), high-income countries had vaccinated 18.6 percent of their total populations before sanctioning broad vaccine access. For low-income groups, this number stands at just 0.4 percent, suggesting that a significantly more modest proportion of these priority groups would have been vaccinated. In combination with the low supply faced throughout 2021, this may have further exacerbated vaccine coverage for the most vulnerable groups, whose ability to compete for vaccine access may be limited.

With country prioritisation orders, the initial proportion of vaccines administered to people from exposed or clinically vulnerable groups is expected to be high, while overall vaccine coverage for the entire population remains relatively low. For instance, a rapid analysis of vaccination trends reveals that, on average, EU/EEA countries had successfully vaccinated 73% of their healthcare workers and 54% of their elderly populations before they expanded vaccination to every adult. Due to their stringent prioritisation policies, on average, 75% of all fully vaccinated people were members of one of these two groups.

Timeseries data for vaccination rates among priority groups in African countries is currently unavailable to assess their coverage prior to universal eligibility. However, as of April 6, 2022, most countries in the region have successfully surpassed 40 percent uptake among healthcare workers, WHO’s lower-end threshold for high coverage^[2], including countries in the first phases of vaccination with overall coverage below 20 percent. Yet, nearly 18 months after the first COVID-19 vaccine dose was administered globally, five African countries have still been unable to protect a significant proportion of their frontline healthcare workers.

WHO recommends that every country achieves very high vaccination coverage for older adults, who are at substantially higher clinical risk. However, there are significant gaps in the level of protection for older adults in African countries, as 15 of the 27 countries for which there is data have vaccinated less than 40 percent of individuals from this priority group. This includes a subset of countries whose vaccination campaigns are slightly more advanced and are approaching 20 percent overall coverage, suggesting that even though very low vaccine supply to the region has been an issue throughout 2021, it does not fully explain these relatively low rates. Moreover, broad vaccine eligibility may further impair vaccine access for older adults who are likely to be disadvantaged in competing for their doses.

At the time when they expanded their vaccination campaigns, lower-income countries reported significant obstacles to their rollouts. For instance, in Cameroon, which extended vaccine eligibility less than two months after administering its first dose, vaccine hesitancy was widespread, as only one in five healthcare workers had accepted the vaccine^[3] and 37 percent of doctors were unwilling to receive any COVID-19 vaccine^[4]. Significant financial constraints were also impairing the country’s ability to conduct a widespread communication campaign to address reluctance to vaccination[5] and to recruit sufficient healthcare personnel[6]. Thus, in the context of the very limited supply throughout most of 2021, the government was facing the risk of vaccine expiration coupled with significant uncertainty about the arrival of the next vaccine delivery. Similarly, Malawi had received a large shipment of vaccines with a short shelf life[7] and, despite immediately deploying them and expanding coverage to all adults just 26 days after initiating its vaccination campaign, was unable to administer nearly 20 percent of them before the doses expired^[8,9].

The emergence and rapid spread of novel variants of concern has underscored that no one is safe until everyone is, and universal vaccine access is critical to ameliorating the significant impacts of this pandemic. Yet, prioritizing vaccine access for vulnerable groups can have a greater impact on reducing hospitalisations, deaths, and socioeconomic effects per dose than a first come, first served approach, which threatens to leave out vulnerable and marginalized groups who tend do have lower mobility and access to information. With continued interventions to support vaccine uptake among vulnerable groups, countries can begin to narrow the preexisting inequities that the pandemic has already exposed and exacerbated. For instance, in parallel to expanding vaccine eligibility to all adults, Rwanda initiated door-to-door vaccinations, bringing the vaccine to older adults^[10]. Similarly, in Kenya, a multilateral partnership between the World Health Organization, local governments, non-governmental organizations and the private sector coordinated a large-scale vaccination campaign to dispel misconceptions and provide vaccine access to people living with disabilities, people without a home, and other marginalised groups^[11].