COVID vaccine: who's getting it first?

How do we decide the priority list for receiving a COVID vaccine?
23 November 2020

Interview with 

Philip Clarke, The University of Oxford




Now that vaccines are looking like a realistic prospect, conversations are turning to who should be vaccinated first. The UK's Joint Committee on Vaccination and Immunisation - or JCVI - have published a priority pecking order that’s based chiefly on age. But this was drawn up a while ago, before the second wave arrived, so we wanted to know what factors had been taken into account when this was put together, and whether the strategy is necessarily still the best one. Chris Smith spoke with Philip Clarke, a health economist at Oxford University…

Philip - People who are older tend to be at greater risk of contracting it, and certainly at greater risk of dying. So it makes a lot of sense to use age as a key factor in allocating a vaccine, but there are also other factors one may consider. Why they've gone with age: because they see it as a very simple way to allocate a vaccine. Everyone knows how old they are, but also you can check that when allocating it to individuals in the community.

Chris - And is that broadly what most countries worldwide are doing?

Philip - They're doing some combinations of that. Most countries have recognised all the people in the community should be vaccinated. The age cutoff currently in the UK is at 50; whereas, for example, in a country like France they are only promising to vaccinate above 65 unless you have another health issue.

Chris - What about the fact that we've actually got a mosaic across the country? Some places have got lots of disease activity and lots of older people; some parts of the country have got very low levels of disease activity and a totally different ratio or proportion of older, more vulnerable people. Is that taken into account with these guidelines, or are we just basically planning to treat Cornwall with extremely low levels the same as Manchester with extremely high levels?

Philip - Certainly the guidelines don't distinguish regionally within the United Kingdom. They were written prior to the second wave of the pandemic. And it does seem to make sense to revisit that, because I think what we know from other vaccinations in the context of pandemics is that vaccinating people with the highest risk in the regions where there is the highest transmission is likely to the most good. But this is something where I think the epidemiological modelling could really help inform the trade-offs. Of course there are also logistics of trying to get vaccines across the country, although I think one needs to look at the potential gains from a much more targeted strategy.

Chris - Could part of that targeted strategy also include more emphasis on occupations? Because if you look at data from different parts of the country collected at the peak of the first wave of coronavirus in the UK, there were certain groups that emerged - certain occupational groups, in certain parts of the country - at very high risk. And that doesn't seem to be featuring so much in what the JCVI are proposing.

Philip - That's very true. It's a very clinically orientated view in terms of using age as the primary risk factor, but then also using people who have got various healthcare conditions - such as having diabetes - which also place them at higher risk. And just to give you an idea of the types of risks we're talking about: your risk of dying of COVID effectively doubles about every five years, right? But if you have diabetes, for example, it means you're equivalent in risk to somebody who's probably 5-10 years older. So I think it does make sense potentially to take into account other factors, other conditions; but also the risk of dying of COVID, we very much know, is related to your occupation. There were occupations in the first wave of COVID - for example, taxi drivers in London, and also some people working in the service industry - who had much higher rates than healthcare workers. And so again, I think bringing in those additional factors in addition to the clinical factors will help target the vaccine to where it's likely to do the most good.


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