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Smith MJ. Why we should not 'just use age' for COVID-19 vaccine prioritisation. JOURNAL OF MEDICAL ETHICS 2022; 48:538-541. [PMID: 34244345 PMCID: PMC8275364 DOI: 10.1136/medethics-2021-107443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
Older age is one of the greatest risk factors for severe outcomes from COVID-19. If we believe it is important to use limited supplies of COVID-19 vaccines to protect the most vulnerable and prevent deaths, then available doses should be allocated with significant priority to older adults. Yet, we should resist the conclusion that age should be the sole criterion for COVID-19 vaccine prioritisation or that no younger populations (eg, those under the age of 60) should be prioritised until all older adults have been vaccinated. This article examines arguments that are commonly presented to abandon 'complex' vaccine prioritisation schemes in favour of 'just using age' (eg, prioritising those 80 years of age and older and then decreasing in a 5-year age bands until the entire population has had the opportunity to be vaccinated), and articulates the ethical reasons why these arguments are not persuasive.
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Affiliation(s)
- Maxwell J Smith
- Faculty of Health Sciences, Western University, London, Ontario, Canada
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2
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Rasambainarivo F, Ramiadantsoa T, Raherinandrasana A, Randrianarisoa S, Rice BL, Evans MV, Roche B, Randriatsarafara FM, Wesolowski A, Metcalf JC. Prioritizing COVID-19 vaccination efforts and dose allocation within Madagascar. BMC Public Health 2022; 22:724. [PMID: 35413894 PMCID: PMC9002044 DOI: 10.1186/s12889-022-13150-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background While mass COVID-19 vaccination programs are underway in high-income countries, limited availability of doses has resulted in few vaccines administered in low and middle income countries (LMICs). The COVID-19 Vaccines Global Access (COVAX) is a WHO-led initiative to promote vaccine access equity to LMICs and is providing many of the doses available in these settings. However, initial doses are limited and countries, such as Madagascar, need to develop prioritization schemes to maximize the benefits of vaccination with very limited supplies. There is some consensus that dose deployment should initially target health care workers, and those who are more vulnerable including older individuals. However, questions of geographic deployment remain, in particular associated with limits around vaccine access and delivery capacity in underserved communities, for example in rural areas that may also include substantial proportions of the population. Methods To address these questions, we developed a mathematical model of SARS-CoV-2 transmission dynamics and simulated various vaccination allocation strategies for Madagascar. Simulated strategies were based on a number of possible geographical prioritization schemes, testing sensitivity to initial susceptibility in the population, and evaluating the potential of tests for previous infection. Results Using cumulative deaths due to COVID-19 as the main outcome of interest, our results indicate that distributing the number of vaccine doses according to the number of elderly living in the region or according to the population size results in a greater reduction of mortality compared to distributing doses based on the reported number of cases and deaths. The benefits of vaccination strategies are diminished if the burden (and thus accumulated immunity) has been greatest in the most populous regions, but the overall strategy ranking remains comparable. If rapid tests for prior immunity may be swiftly and effectively delivered, there is potential for considerable gain in mortality averted, but considering delivery limitations modulates this. Conclusion At a subnational scale, our results support the strategy adopted by the COVAX initiative at a global scale. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13150-8.
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Affiliation(s)
- Fidisoa Rasambainarivo
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA. .,Mahaliana Labs SARL, Antananarivo, Madagascar.
| | - Tanjona Ramiadantsoa
- Department of Life Science, University of Fianarantsoa, Antananarivo, Madagascar.,Department of Mathematics, University of Fianarantsoa, Antananarivo, Madagascar.,MIVEGEC, Université de Montpellier, CNRS, Montpellier, IRD, France
| | - Antso Raherinandrasana
- Surveillance Unit, Ministry of Health of Madagascar, Antananarivo, Madagascar.,Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | - Benjamin L Rice
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.,Madagascar Health and Environmental Research (MAHERY), Maroantsetra, Madagascar
| | - Michelle V Evans
- MIVEGEC, Université de Montpellier, CNRS, Montpellier, IRD, France
| | - Benjamin Roche
- MIVEGEC, Université de Montpellier, CNRS, Montpellier, IRD, France
| | - Fidiniaina Mamy Randriatsarafara
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar.,Direction of Preventive Medicine, Ministry of Health of Madagascar, Antananarivo, Madagascar
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica C Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.,Princeton School of Public and International Affairs, Princeton University, Princeton, NJ, USA
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3
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Mishra S, Ma H, Moloney G, Yiu KCY, Darvin D, Landsman D, Kwong JC, Calzavara A, Straus S, Chan AK, Gournis E, Rilkoff H, Xia Y, Katz A, Williamson T, Malikov K, Kustra R, Maheu-Giroux M, Sander B, Baral SD. Increasing concentration of COVID-19 by socioeconomic determinants and geography in Toronto, Canada: an observational study. Ann Epidemiol 2022; 65:84-92. [PMID: 34320380 DOI: 10.1101/2021.04.01.21254585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND Inequities in the burden of COVID-19 were observed early in Canada and around the world, suggesting economically marginalized communities faced disproportionate risks. However, there has been limited systematic assessment of how heterogeneity in risks has evolved in large urban centers over time. PURPOSE To address this gap, we quantified the magnitude of risk heterogeneity in Toronto, Ontario from January to November 2020 using a retrospective, population-based observational study using surveillance data. METHODS We generated epidemic curves by social determinants of health (SDOH) and crude Lorenz curves by neighbourhoods to visualize inequities in the distribution of COVID-19 and estimated Gini coefficients. We examined the correlation between SDOH using Pearson-correlation coefficients. RESULTS Gini coefficient of cumulative cases by population size was 0.41 (95% confidence interval [CI]:0.36-0.47) and estimated for: household income (0.20, 95%CI: 0.14-0.28); visible minority (0.21, 95%CI:0.16-0.28); recent immigration (0.12, 95%CI:0.09-0.16); suitable housing (0.21, 95%CI:0.14-0.30); multigenerational households (0.19, 95%CI:0.15-0.23); and essential workers (0.28, 95%CI:0.23-0.34). CONCLUSIONS There was rapid epidemiologic transition from higher- to lower-income neighborhoods with Lorenz curve transitioning from below to above the line of equality across SDOH. Moving forward necessitates integrating programs and policies addressing socioeconomic inequities and structural racism into COVID-19 prevention and vaccination programs.
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Affiliation(s)
- Sharmistha Mishra
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
| | - Huiting Ma
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Gary Moloney
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Kristy C Y Yiu
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Dariya Darvin
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - David Landsman
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | | | - Sharon Straus
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Adrienne K Chan
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences, University of Toronto, Toronto, Canada
| | - Effie Gournis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Toronto Public Health, City of Toronto, Toronto, Canada
| | | | - Yiqing Xia
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada
| | - Alan Katz
- Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada
| | - Kamil Malikov
- Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada
| | - Beate Sander
- ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, United States
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Dryden-Peterson S, Velásquez GE, Stopka TJ, Davey S, Gandhi RT, Lockman S, Ojikutu BO. Disparities in SARS-CoV-2 Vaccination-to-Infection Risk During the COVID-19 Pandemic in Massachusetts. JAMA HEALTH FORUM 2021; 2:e212666. [PMID: 35977180 PMCID: PMC8796904 DOI: 10.1001/jamahealthforum.2021.2666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/23/2021] [Indexed: 01/13/2023] Open
Abstract
This cohort study examines the alignment of vaccination and SARS-CoV-2 risk in Massachusetts by creating and applying a vaccination-to-infection risk ratio.
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Affiliation(s)
- Scott Dryden-Peterson
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana-Harvard AIDS Institute, Boston, Massachusetts
| | - Gustavo E. Velásquez
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Boston, Massachusetts
- Department of Urban and Environmental Policy and Planning, Graduate School of Arts and Sciences, Tufts University, Medford, Massachusetts
- Department of Community Health, School of Arts and Sciences, Tufts University, Medford, Massachusetts
| | - Sonya Davey
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rajesh T. Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | - Shahin Lockman
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana-Harvard AIDS Institute, Boston, Massachusetts
| | - Bisola O. Ojikutu
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
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Mishra S, Ma H, Moloney G, Yiu KC, Darvin D, Landsman D, Kwong JC, Calzavara A, Straus S, Chan AK, Gournis E, Rilkoff H, Xia Y, Katz A, Williamson T, Malikov K, Kustra R, Maheu-Giroux M, Sander B, Baral SD. Increasing concentration of COVID-19 by socioeconomic determinants and geography in Toronto, Canada: an observational study. Ann Epidemiol 2021; 65:84-92. [PMID: 34320380 PMCID: PMC8730782 DOI: 10.1016/j.annepidem.2021.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Inequities in the burden of COVID-19 were observed early in Canada and around the world suggesting economically marginalized communities faced disproportionate risks. However, there has been limited systematic assessment of how heterogeneity in risks has evolved in large urban centers over time. PURPOSE To address this gap, we quantified the magnitude of risk heterogeneity in Toronto, Ontario from January-November, 2020 using a retrospective, population-based observational study using surveillance data. METHODS We generated epidemic curves by social determinants of health (SDOH) and crude Lorenz curves by neighbourhoods to visualize inequities in the distribution of COVID-19 and estimated Gini coefficients. We examined the correlation between SDOH using Pearson-correlation coefficients. RESULTS Gini coefficient of cumulative cases by population size was 0.41 (95% confidence interval [CI]:0.36-0.47) and estimated for: household income (0.20, 95%CI: 0.14-0.28); visible minority (0.21, 95%CI:0.16-0.28); recent immigration (0.12, 95%CI:0.09-0.16); suitable housing (0.21, 95%CI:0.14-0.30); multi-generational households (0.19, 95%CI:0.15-0.23); and essential workers (0.28, 95%CI:0.23-0.34). CONCLUSIONS There was rapid epidemiologic transition from higher to lower income neighbourhoods with Lorenz curve transitioning from below to above the line of equality across SDOH. Moving forward necessitates integrating programs and policies addressing socioeconomic inequities and structural racism into COVID-19 prevention and vaccination programs.
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Affiliation(s)
- Sharmistha Mishra
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
| | - Huiting Ma
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Gary Moloney
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Kristy Cy Yiu
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Dariya Darvin
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - David Landsman
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Jeffrey C Kwong
- ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Sharon Straus
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Adrienne K Chan
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Effie Gournis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Toronto Public Health, City of Toronto, Toronto, Canada.
| | | | - Yiqing Xia
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada.
| | - Alan Katz
- Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada.
| | - Kamil Malikov
- Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada.
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada.
| | - Beate Sander
- ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, United States.
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- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Toronto Public Health, City of Toronto, Toronto, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada; Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada; Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, United States
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Ma KC, Menkir TF, Kissler S, Grad YH, Lipsitch M. Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics. eLife 2021; 10:e66601. [PMID: 34003112 PMCID: PMC8221808 DOI: 10.7554/elife.66601] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background The impact of variable infection risk by race and ethnicity on the dynamics of SARS-CoV-2 spread is largely unknown. Methods Here, we fit structured compartmental models to seroprevalence data from New York State and analyze how herd immunity thresholds (HITs), final sizes, and epidemic risk change across groups. Results A simple model where interactions occur proportionally to contact rates reduced the HIT, but more realistic models of preferential mixing within groups increased the threshold toward the value observed in homogeneous populations. Across all models, the burden of infection fell disproportionately on minority populations: in a model fit to Long Island serosurvey and census data, 81% of Hispanics or Latinos were infected when the HIT was reached compared to 34% of non-Hispanic whites. Conclusions Our findings, which are meant to be illustrative and not best estimates, demonstrate how racial and ethnic disparities can impact epidemic trajectories and result in unequal distributions of SARS-CoV-2 infection. Funding K.C.M. was supported by National Science Foundation GRFP grant DGE1745303. Y.H.G. and M.L. were funded by the Morris-Singer Foundation. M.L. was supported by SeroNet cooperative agreement U01 CA261277.
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Affiliation(s)
- Kevin C Ma
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Tigist F Menkir
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
| | - Stephen Kissler
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical SchoolBostonUnited States
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
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