Rural prioritization may increase the impact of COVID-19 vaccines in a representative COVAX AMC country setting due to ongoing internal migration: A modeling study.

Autor:	Selvaraj P; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America., Wagner BG; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America., Chao DL; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America., Jackson ML; Coalition for Epidemic Preparedness and Innovations, Oslo, Norway., Breugelmans JG; Coalition for Epidemic Preparedness and Innovations, London, United Kingdom., Jackson N; Coalition for Epidemic Preparedness and Innovations, London, United Kingdom., Chang ST; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 Jan 27; Vol. 2 (1), pp. e0000053. Date of Electronic Publication: 2022 Jan 27 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0000053
Abstrakt:	How COVID-19 vaccine is distributed within low- and middle-income countries has received little attention outside of equity or logistical concerns but may ultimately affect campaign impact in terms of infections, severe cases, or deaths averted. In this study we examined whether subnational (urban-rural) prioritization may affect the cumulative two-year impact on disease transmission and burden of a vaccination campaign using an agent-based model of COVID-19 in a representative COVID-19 Vaccines Global Access (COVAX) Advanced Market Commitment (AMC) setting. We simulated a range of vaccination strategies that differed by urban-rural prioritization, age group prioritization, timing of introduction, and final coverage level. Urban prioritization averted more infections in only a narrow set of scenarios, when internal migration rates were low and vaccination was started by day 30 of an outbreak. Rural prioritization was the optimal strategy for all other scenarios, e.g., with higher internal migration rates or later start dates, due to the presence of a large immunological naive rural population. Among other factors, timing of the vaccination campaign was important to determining maximum impact, and delays as short as 30 days prevented larger campaigns from having the same impact as smaller campaigns that began earlier. The optimal age group for prioritization depended on choice of metric, as prioritizing older adults consistently averted more deaths across all of the scenarios. While guidelines exist for these latter factors, urban-rural allocation is an orthogonal factor that we predict to affect impact and warrants consideration as countries plan the scale-up of their vaccination campaigns. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2022 Selvaraj et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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