Health and Healthcare Systems

How countries are dealing with the delicate matter of who to vaccinate first

A medic fills a syringe with COVAXIN, an Indian government-backed experimental COVID-19 vaccine, before administering it to a health worker during its trials, at the Gujarat Medical Education and Research Society in Ahmedabad, India, November 26, 2020. REUTERS/Amit Dave - RC2YAK9TYO76

A medic fills a syringe with an experimental COVID-19 vaccine before administering it to a health worker during trials in Ahmedabad, India, November 26, 2020. Image: REUTERS/Amit Dave - RC2YAK9TYO76

John Letzing
Digital Editor, World Economic Forum
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  • Officials around the world are sorting out who will be first in line for COVID-19 vaccinations.
  • The UK should receive its first doses for distribution next week, and the US may soon follow.
  • However, people in low-income countries may have to wait years before they’re vaccinated.

COVID-19 vaccines should start becoming available in the Western world for the first time in a matter of days. So, who should be given early access?

Officials far and wide have been delving into the delicate process of deciding who will receive the initial, limited batches of vaccines as they thread together the complex supply chains necessary to deliver them.

In the UK, which became the first Western country to grant emergency-use authorization for a COVID-19 vaccine, nursing home residents and staff are technically first in line for doses expected to arrive next week. Germany may also prioritise the elderly (depending on whether doses prove to be too potent), Japan plans to issue coupons for its first doses designated for senior citizens, while Indonesia plans to prioritise workers as young as 18.

In Australia, the initial priority groups identified include Aboriginal and Torres Strait Islander people. And a vote in the US on Tuesday means a mix of health care workers and nursing home residents will be prioritised for that country’s first supply – which might become available later this month.

People in low-income countries that were not privy to the billions of doses that had been acquired by last month might find themselves at the back of the global line. Moderna may charge as much as $37 for a single dose under a “cheaper” pricing program, for example, though AstraZeneca and Oxford University have committed to selling doses for as little as $2. Still, experts think many residents of poorer countries might have to wait until as late as 2024 for vaccinations.

One international initiative, the COVAX Facility, aims to pool resources among wealthy and poor nations to ensure more equitable vaccine access, and has secured hundreds of millions of doses. The success of COVAX is not certain, however, and countries like the US and Russia have opted to not participate (the US may yet under a new administration).

Image: World Economic Forum

After receiving the first available doses, many people will still have to wait weeks before they’re actually vaccinated. Moderna’s vaccine requires a four-week gap between a first and second required dose, for example.

Initial vaccinations will cover relatively small parts of each country’s population. While the UK has ordered enough doses for about a third of its residents, only 800,000 doses are expected to arrive in its first batch next week. Other countries that more successfully managed the outbreak, such as South Korea, have taken a more deliberate approach to securing initial supplies.

One problem that may arise as doses become available is a reluctance to take them. Less than two-thirds of health care workers in the US polled recently said they’d get a COVID-19 vaccine. Surveys conducted among the broader US population showed that only half would agree to a free vaccination as of September, though that has since increased to nearly 60%.

Image: World Economic Forum

Another nagging question: it remains unknown whether those vaccinated will still be able to pass the virus on to others, even if they’ve protected themselves from getting sick.

For more context, here are links to further reading from the World Economic Forum’s Strategic Intelligence platform:

  • National and private interests are trumping the principle of health justice, according to this analysis, and there is still a long way to go to deliver on the promise of a universal, freely-available “people’s vaccine.” (Project Syndicate)
  • No one really expects doses to be distributed equitably, according to this analysis – local manufacturing deals are likely to help determine where the first shipments go, leaving dwindling short-term supplies for low- and middle-income countries. (Nature)
  • Australia has signalled it will guarantee access to vaccines for its Pacific Island neighbours; this analysis argues the country should also seize the opportunity to forge closer ties with India by investing in the vaccine rollout there. (The Diplomat)
  • Under any circumstances, putting medicine into glass is a tricky business, according to this report. Soon, getting vaccines to the people who need them will require more than a billion vials to be manufactured, filled, and shipped, at top speed and in some cases under extreme stress. (The New Yorker)
  • Differing opinions in the US over giving the first vaccinations to older adults (favoured by members of the Trump administration) or health care workers (the choice of a committee advising the CDC) risked sending mixed signals to state authorities finalizing deployment plans, according to this report. (STAT)
  • China National Pharmaceutical Group recently filed for approval to release a COVID-19 vaccine to the public, according to this report – after two of its vaccines had been tested in 10 different countries in South America and the Middle East. (Radii)
  • The announcement that a vaccine candidate from Pfizer and BioNTech protects 95% of people from COVID-19 was a rare case of a corporate media release making the biggest news of the week. In this analysis, two health reporters break down what it did and – crucially – didn’t say. (Global Investigative Journalism Network)

On the Strategic Intelligence platform, you can find feeds of expert analysis related to COVID-19, Vaccination and hundreds of additional topics. You’ll need to register to view.

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