Which countries need COVID-19 vaccines the most? Development of a prioritisation tool

  1. Vageesh Jain
  2. Rifat Atun
  3. Paul Hansen
  4. Paula Lorgelly

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Abstract

Background

The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) have affected all countries. With a scarcity of COVID-19 vaccines there has been a need to prioritize populations, but assessing relative needs has been challenging. The COVAX Facility allocates vaccines to cover 20% of each national population, followed by a needs assessment that considers five quantitative metrics alongside a qualitative assessment. The objective of this study was to identify the most important factors for assessing countries’ needs for vaccines, and to weight each, generating a scoring tool for prioritising countries.

Methods

The study was conducted between March and November 2021. The first stage involved an online Delphi survey with a purposive and snowball sample of public health experts, to reach consensus on country-level factors for assessing relative needs for COVID-19 vaccines. The second stage involved a discrete choice experiment (DCE) to determine weights for the most important factors.

Results

Responses were received from 28 experts working across 13 different countries and globally. The most common job titles reported were director and professor, with most based in national public health institutes ( n  = 9) and universities ( n  = 8). The Delphi survey found 37 distinct factors related to needs. Nine of the most important factors were included in the DCE. Among these, the most important factor was the ‘proportion of overall population not fully vaccinated’ (with a mean weight of 19.5), followed by ‘proportion of high-risk population not fully vaccinated’ (16.1), ‘health system capacity’ (14.2), ‘capacity to purchase vaccines’ (11.9) and the ‘proportion of the population clinically vulnerable’ (11.3).

Conclusions

Several factors exist, extending beyond those currently used, which may lead to some countries having a greater need for vaccines compared to others. By assessing relative needs, this scoring tool can build on existing methods to further the role of equity in global COVID-19 vaccine allocation.

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  1. Version published to 10.1186/s12889-022-13948-6
  2. ScreenIT

    SciScore for 10.1101/2022.04.27.22274377: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The study was approved by the UCL Research Ethics Committee (17229/002).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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:
    Limitations: Although we were able to include a wide range of experts in this study, our findings may not necessarily be representative of all experts in the field. Having said this, the tool improves on existing priority-setting mechanisms. Factors were only included if reported by multiple experts working across several countries and institutions, and determining their weights was performed using a choice-based exercise (the DCE) instead of more traditional questionnaire or ranking methods. In addition, the study was limited by a response rate of approximately 50% of the experts we invited. Although all participants initially agreed to participate, most of them were actively contributing to the pandemic response, leading to significant time pressures, meaning that many were unable to complete the DCE. The mean weights for some factors may have been different with additional participants, although large changes would be required for the ranking of the factors to change substantially. The study also started before booster doses were widely used, meaning that the factors and weights identified may differ for the exclusive allocation of booster doses, given differences in epidemiological utility for disease control and severity compared to primary course vaccination (18,29,30). Finally, we were limited in the amount of contextual detail we were able to provide in the DCE survey. There may have been further factors, beyond the two outlined for each country, that influenced decis...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.04.27.22274377v1 on medRxiv