Ranking the relative importance of COVID-19 immunisation strategies: a survey of expert stakeholders in Canada

  1. Linlu Zhao
  2. Shainoor J. Ismail
  3. Matthew C. Tunis

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Abstract

Background

In the face of anticipated limited COVID-19 vaccine supply necessitating the vaccination of certain groups earlier than others, the assessment of values and preferences of stakeholders is an important component of an ethically sound vaccine prioritisation framework.

Objective

To establish a preliminary expert stakeholder perspective on the relative importance of pandemic immunisation strategies for different COVID-19 pandemic scenarios at the time of initial COVID-19 vaccine availability.

Methods

A survey was conducted by an email process from July 22 to August 14, 2020. Stakeholders included clinical and public health expert groups, provincial and territorial committees and national Indigenous groups, patient and community advocacy representatives and experts, health professional associations, and federal government departments in Canada. Survey results were analysed using descriptive statistics.

Results

Of 156 stakeholders contacted, 74 surveys were completed for a participation rate of 47.4%. During an anticipated period of initial vaccine scarcity for all pandemic scenarios, stakeholders generally considered the most important immunisation strategy to be protecting those who are most vulnerable to severe illness and death from COVID-19. This was followed in importance by the strategies to protect healthcare capacity, and to minimise transmission of COVID-19. In this supply constrained context, an immunisation strategy to protect critical infrastructure was considered the least important.

Conclusion

The findings of this study provide a timely, preliminary Canadian expert perspective on priority COVID-19 pandemic immunisation strategies to guide early public health planning for an eventual COVID-19 immunisation program. These results fill a gap in the literature and could help advisory groups around the world in their assessment of values and preferences for ethical guidelines for COVID-19 vaccine allocation.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.16.20196295: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study received approval from the Health Canada and the Public Health Agency of Canada Research Ethics Board (REB 2020-011P).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are a number of important limitations to consider when interpreting the findings of this study. First, stakeholders were forced to treat the immunisation strategies presented in the survey as distinct, when in reality these strategies are overlapping to some degree. For example, those working in long-term care facilities could be targeted under all four immunisation strategies that were presented for ranking. Second, this study surveyed “key informant” stakeholders who acted as a proxy for their organisation or stakeholder group. Though respondents were encouraged to consult with others in their organisations, the survey responses may not be representative opinions of the respective organisations or groups. Third, the survey questions presented broad concepts that were open to interpretation. Respondents likely made differing assumptions based on their values and preferences in order to provide rankings. Despite these limitations, the overall ranking of this expert survey mirrored surveys of the general public on the prioritisation of pandemic immunisation strategies. Canada’s COVID-19 Snapshot Monitoring Study (COSMO Canada) is a longitudinal study that surveyed a representative sample of approximately 2000 Canadians from April through September 2020 in eight waves [6]. When asked in Wave 7 (August 13–17, 2020) which immunisation strategies they would prioritise if COVID-19 vaccine supply is limited, a majority of respondents identified protecting those most vulnerable...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.09.16.20196295v1 on medRxiv