#15,597
Now that several COVID-19 vaccines are poised to enter the market (albeit initially in limited quantities), the next and arguably hardest step - getting it into the arms of enough people to significantly slow or mitigate the impact of the pandemic - lies ahead.
Decisions must now be made about who gets first access to the vaccine, how and where they will be dispensed, how they will monitor recipients for safety, effectiveness and uptake, and how they can manage the public's expectations and concerns.
It's a big job, perhaps the most ambitious global public health undertaking in history, and there is no one-size-fits-all strategies. Different countries will attack this problem in different ways.
Earlier this week the CDC's ACIP (Advisory Committee on Immunization Practices) voted on the first groups to be offered a vaccine in the United States; assuming one is authorized this month or next.
December 1, 2020 Meeting Recommendation
ACIP approved the following recommendation by majority (13-1) vote at its December 1, 2020 emergency meeting.
When a COVID-19 vaccine is authorized by FDA and recommended by ACIP, vaccination in the initial phase of the COVID-19 vaccination program (Phase 1a) should be offered to both 1) health care personnel§ and 2) residents of long-term care facilities¶
This recommendation has been adopted by the CDC Director.
§Health care personnel are defined as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials
¶ Long-term care facility residents are defined as adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently
Phase 1a covers about 24 million Americans (21 million HCWs, 3 million residents of LTCFs). or about 7% of the population. As each person will require two shots - roughly a month apart - this will require administering (and keeping track of) between 40 and 50 million doses (depending on uptake).
Decisions about the next priority groups (i.e. essential workers, those over 65 or with co-morbidities, etc.) to target will be made in the weeks and months ahead, based - in part - on how well this first roll out goes.
Similar plans are being formulated around the globe, including in Europe and the UK. Yesterday the ECDC released a 22-page preliminary technical report on their plans and strategies for deploying a COVID vaccine across more than 30 member nations.
As you'll see - as in the United States - the EU's plans are still very much in the development phase.
Overview of COVID-19 vaccination strategies and vaccine deployment plans in the EU/EEA and the UK
Technical report
2 Dec 2020
This document outlines the initial developments in EU/EEA member states and the UK regarding vaccine deployment plans and national vaccination strategies for COVID-19 vaccines, including interim considerations for priority groups, evidence to be considered for the prioritisation of target groups, logistical considerations and monitoring systems for post-marketing surveillance (e.g. vaccine coverage, safety, effectiveness and acceptance).
Executive summary
Key findings
This report provides an initial overview of the national COVID-19 vaccination strategies and vaccine deployment plans in the countries of the European Union and European Economic Area (EU/EEA) and the United Kingdom (UK).
This overview is based on results from an ECDC survey and meeting among members of the EU/EEA National Immunisation Technical Advisory Groups (NITAG) Collaboration in October 2020 and a survey undertaken by the Health Security and Vaccination unit of the European Commission’s Directorate-General for Health and Food Safety with members of the EU Health Security Committee (HSC) in November 2020.
This report provides insights into the main aspects of national deployment plans currently under development in countries. The information presented will continue to evolve in the coming weeks and months as countries further develop their vaccine deployment plans and more information becomes available on the different characteristics of various COVID-19 vaccines.
Initial considerations for priority groups and underlying evidence
All 31 EU/EEA countries and the UK responding to the ECDC survey have started evaluating available information with the goal of establishing interim recommendations for first priority groups for vaccination. As of 30 November 2020, nine countries had already published interim recommendations for priority groups (Austria, Belgium, Czechia, France, Luxembourg, the Netherlands, Spain, Sweden and the UK).
Countries responding to the ECDC and the HSC surveys and those that have already published recommendations have primarily prioritised elderly people (with various lower age cut-off across countries), healthcare workers and those persons with certain comorbidities. Some countries have started to prioritise further among the priority groups selected for first vaccination, as it is probable that vaccine doses will be in limited supply in the initial phase of the vaccination campaigns.
Prioritisation groups may also be modified as more evidence becomes available about the COVID-19 disease epidemiology and characteristics of vaccines, including information on vaccine safety and efficacy by age and target group.
Modelling different options for vaccine efficacy for different outcomes (including severe disease, mild disease, infection and infectivity, and death) and vaccine uptake in EU populations, as well as different scenarios for prioritisation, is an important step that will inform decisions on vaccination strategies and estimate their possible impact.
Logistical considerations
Monitoring systems for vaccine coverage, safety, effectiveness, and acceptance
- For the roll-out of future COVID-19 vaccines, many countries will make use of existing vaccination structures and delivery services as much as possible. Responses from the HSC survey showed that some countries were planning to train more people to carry out the vaccinations.
- Several countries indicated that there is a need to procure additional equipment for the cold-chain requirements due to the ultra-low temperature required for some of the COVID-19 vaccines.
- Most countries reported that COVID-19 vaccines will be provided free of charge for their citizens.
Electronic immunisation registries for the monitoring of individual and population-level vaccine uptake are available at the national or subnational level in 13 countries, and developments towards such national systems are ongoing in 10 further countries. Two countries have an insurance-based system that will be used for the monitoring of vaccine uptake. Documentation regarding which vaccine product has been administered and when is key to the success of vaccination programmes. Such documentation is also important for monitoring any safety signals, such as an adverse event following immunisation (AEFI) that may arise for any of the vaccine products. Information in these registries could serve as the basis for immunisation cards.
Limitation of the information collected
The information collected in this report is not intended to be exhaustive. Most of the countries are currently in the development phase of their deployment plans, and the questions in the surveys were also mostly open-ended in nature, so some information may not have been captured. ECDC is planning to issue a new interim report in January.
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Overview of COVID-19 vaccination strategies and vaccine deployment plans in the EU/EEA and the UK - EN - [PDF-624.72 KB]
While I am heartened by the apparent progress made to date with the development of COVID vaccines, there remains a long and difficult road ahead before they can be expected to significantly dampen the pandemic.
Most of us will have to get through this winter without the benefit of a vaccine, relying on face covers, hand hygiene, social distancing, and a little luck.
But if the vaccines live up to the early hype, and if the public's acceptance and uptake is sufficiently high enough, then we could see some genuine relief by the fall of 2021. It's a tall order, and a lot of things will have to go very `right' in the months ahead.
But for now, that appears to be our best path forward.
