Adaptive and optimized COVID-19 vaccination strategies across geographical regions and age groups

Learning from the COVID-19 pandemic: A systematic review of mathematical vaccine prioritization models

As the world becomes ever more connected, the chance of pandemics increases as well. The recent COVID-19 pandemic and the concurrent global mass vaccine roll-out provides an ideal setting to learn from and refine our understanding of infectious disease models for better future preparedness. In this review, we systematically analyze and categorize mathematical models that have been developed to design optimal vaccine prioritization strategies of an initially limited vaccine. As older individuals are disproportionately affected by COVID-19, the focus is on models that take age explicitly into account. The lower mobility and activity level of older individuals gives rise to non-trivial trade-offs. Secondary research questions concern the optimal time interval between vaccine doses and spatial vaccine distribution. This review showcases the effect of various modeling assumptions on model outcomes. A solid understanding of these relationships yields better infectious disease models and thus public health decisions during the next pandemic.

Optimal vaccine allocation strategy: Theory and application to the early stage of COVID-19 in Japan

In this paper, we construct an age-structured epidemic model to analyze the optimal vaccine allocation strategy in an epidemic. We focus on two topics: the first one is the optimal vaccination interval between the first and second doses, and the second one is the optimal vaccine allocation ratio between young and elderly people. On the first topic, we show that the optimal interval tends to become longer as the relative efficacy of the first dose to the second dose (RE) increases. On the second topic, we show that the heterogeneity in the age-dependent susceptibility (HS) affects the optimal allocation ratio between young and elderly people, whereas the heterogeneity in the contact frequency among different age groups (HC) tends to affect the effectiveness of the vaccination campaign. A counterfactual simulation suggests that the epidemic wave in the summer of 2021 in Japan could have been greatly mitigated if the optimal vaccine allocation strategy had been taken.

The influence of cross-border mobility on the COVID-19 epidemic in Nordic countries

Restrictions of cross-border mobility are typically used to prevent an emerging disease from entering a country in order to slow down its spread. However, such interventions can come with a significant societal cost and should thus be based on careful analysis and quantitative understanding on their effects. To this end, we model the influence of cross-border mobility on the spread of COVID-19 during 2020 in the neighbouring Nordic countries of Denmark, Finland, Norway and Sweden. We investigate the immediate impact of cross-border travel on disease spread and employ counterfactual scenarios to explore the cumulative effects of introducing additional infected individuals into a population during the ongoing epidemic. Our results indicate that the effect of inter-country mobility on epidemic growth is non-negligible essentially when there is sizeable mobility from a high prevalence country or countries to a low prevalence one. Our findings underscore the critical importance of accurate data and models on both epidemic progression and travel patterns in informing decisions related to inter-country mobility restrictions.

Learning from the COVID-19 pandemic: a systematic review of mathematical vaccine prioritization models

As the world becomes ever more connected, the chance of pandemics increases as well. The recent COVID-19 pandemic and the concurrent global mass vaccine roll-out provides an ideal setting to learn from and refine our understanding of infectious disease models for better future preparedness. In this review, we systematically analyze and categorize mathematical models that have been developed to design optimal vaccine prioritization strategies of an initially limited vaccine. As older individuals are disproportionately affected by COVID-19, the focus is on models that take age explicitly into account. The lower mobility and activity level of older individuals gives rise to non-trivial trade-offs. Secondary research questions concern the optimal time interval between vaccine doses and spatial vaccine distribution. This review showcases the effect of various modeling assumptions on model outcomes. A solid understanding of these relationships yields better infectious disease models and thus public health decisions during the next pandemic.

Covid19Vaxplorer: A free, online, user-friendly COVID-19 vaccine allocation comparison tool

There are many COVID-19 vaccines currently available, however, Low- and middle-income countries (LMIC) still have large proportions of their populations unvaccinated. Decision-makers must decide how to effectively allocate available vaccines (e.g. boosters or primary series vaccination, which age groups to target) but LMIC often lack the resources to undergo quantitative analyses of vaccine allocation, resulting in ad-hoc policies. We developed Covid19Vaxplorer (https://covid19vaxplorer.fredhutch.org/), a free, user-friendly online tool that simulates region-specific COVID-19 epidemics in conjunction with vaccination with the purpose of providing public health officials worldwide with a tool for vaccine allocation planning and comparison. We developed an age-structured mathematical model of SARS-CoV-2 transmission and COVID-19 vaccination. The model considers vaccination with up to three different vaccine products, primary series and boosters. We simulated partial immunity derived from waning of natural infection and vaccination. The model is embedded in an online tool, Covid19Vaxplorer that was optimized for its ease of use. By prompting users to fill information through several windows to input local parameters (e.g. cumulative and current prevalence), epidemiological parameters (e.g basic reproduction number, current social distancing interventions), vaccine parameters (e.g. vaccine efficacy, duration of immunity) and vaccine allocation (both by age groups and by vaccination status). Covid19Vaxplorer connects the user to the mathematical model and simulates, in real time, region-specific epidemics. The tool then produces key outcomes including expected numbers of deaths, hospitalizations and cases, with the possibility of simulating several scenarios of vaccine allocation at once for a side-by-side comparison. We provide two usage examples of Covid19Vaxplorer for vaccine allocation in Haiti and Afghanistan, which had as of Spring 2023, 2% and 33% of their populations vaccinated, and show that for these particular examples, using available vaccine as primary series vaccinations prevents more deaths than using them as boosters.

Modeling geographic vaccination strategies for COVID-19 in Norway

Vaccination was a key intervention in controlling the COVID-19 pandemic globally. In early 2021, Norway faced significant regional variations in COVID-19 incidence and prevalence, with large differences in population density, necessitating efficient vaccine allocation to reduce infections and severe outcomes. This study explored alternative vaccination strategies to minimize health outcomes (infections, hospitalizations, ICU admissions, deaths) by varying regions prioritized, extra doses prioritized, and implementation start time. Using two models (individual-based and meta-population), we simulated COVID-19 transmission during the primary vaccination period in Norway, covering the first 7 months of 2021. We investigated alternative strategies to allocate more vaccine doses to regions with a higher force of infection. We also examined the robustness of our results and highlighted potential structural differences between the two models. Our findings suggest that early vaccine prioritization could reduce COVID-19 related health outcomes by 8% to 20% compared to a baseline strategy without geographic prioritization. For minimizing infections, hospitalizations, or ICU admissions, the best strategy was to initially allocate all available vaccine doses to fewer high-risk municipalities, comprising approximately one-fourth of the population. For minimizing deaths, a moderate level of geographic prioritization, with approximately one-third of the population receiving doubled doses, gave the best outcomes by balancing the trade-off between vaccinating younger people in high-risk areas and older people in low-risk areas. The actual strategy implemented in Norway was a two-step moderate level aimed at maintaining the balance and ensuring ethical considerations and public trust. However, it did not offer significant advantages over the baseline strategy without geographic prioritization. Earlier implementation of geographic prioritization could have more effectively addressed the main wave of infections, substantially reducing the national burden of the pandemic.

Covid19Vaxplorer: a free, online, user-friendly COVID-19 Vaccine Allocation Comparison Tool

Background

There are many COVID-19 vaccines currently available, however, Low- and middle-income countries (LMIC) still have large proportions of their populations unvaccinated. Decision-makers must decide how to effectively allocate available vaccines (e.g. boosters or primary series vaccination, which age groups to target) but LMIC often lack the resources to undergo quantitative analyses of vaccine allocation, resulting in ad-hoc policies. We developed Covid19Vaxplorer (https://covid19vaxplorer.fredhutch.org/), a free, user-friendly online tool that simulates region-specific COVID-19 epidemics in conjunction with vaccination with the purpose of providing public health officials worldwide with a tool for vaccine allocation planning and comparison.

Methods

We developed an age-structured mathematical model of SARS-CoV-2 transmission and COVID-19 vaccination. The model considers vaccination with up to three different vaccine products, primary series and boosters. We simulated partial immunity derived from waning of natural infection and vaccination. The model is embedded in an online tool, Covid19Vaxplorer that was optimized for its ease of use. By prompting users to fill information through several windows to input local parameters (e.g. cumulative and current prevalence), epidemiological parameters (e.g basic reproduction number, current social distancing interventions), vaccine parameters (e.g. vaccine efficacy, duration of immunity) and vaccine allocation (both by age groups and by vaccination status). Covid19Vaxplorer connects the user to the mathematical model and simulates, in real time, region-specific epidemics. The tool then produces key outcomes including expected numbers of deaths, hospitalizations and cases, with the possibility of simulating several scenarios of vaccine allocation at once for a side-by-side comparison.

Results

We provide two usage examples of Covid19Vaxplorer for vaccine allocation in Haiti and Afghanistan, which had as of Spring 2023 2% and 33% of their populations vaccinated, and show that for these particular examples, using available vaccine as primary series vaccinations prevents more deaths than using them as boosters. Covid19Vaxplorer allows users in 183 regions in the world to compare several vaccination strategies simultaneously, adjusting parameters to their local epidemics, infrastructure and logistics. Covid19Vaxplorer is an online, free, user-friendly tool that facilitates evidence-based decision making for vaccine distribution.

Analysis of COVID-19 outbreak in Hubei province based on Tencent's location big data

Rapid urbanization has gradually strengthened the spatial links between cities, which greatly aggravates the possibility of the spread of an epidemic. Traditional methods lack the early and accurate detection of epidemics. This study took the Hubei province as the study area and used Tencent's location big data to study the spread of COVID-19. Using ArcGIS as a platform, the urban relation intensity, urban centrality, overlay analysis, and correlation analysis were used to measure and analyze the population mobility data of 17 cities in Hubei province. The results showed that there was high similarity in the spatial distribution of urban relation intensity, urban centrality, and the number of infected people, all indicating the spatial distribution characteristics of "one large and two small" distributions with Wuhan as the core and Huanggang and Xiaogan as the two wings. The urban centrality of Wuhan was four times higher than that of Huanggang and Xiaogan, and the urban relation intensity of Wuhan with Huanggang and Xiaogan was also the second highest in the Hubei province. Meanwhile, in the analysis of the number of infected persons, it was found that the number of infected persons in Wuhan was approximately two times that of these two cities. Through correlation analysis of the urban relation intensity, urban centrality, and the number of infected people, it was found that there was an extremely significant positive correlation among the urban relation intensity, urban centrality, and the number of infected people, with an R2 of 0.976 and 0.938, respectively. Based on Tencent's location big data, this study conducted the epidemic spread research for "epidemic spatial risk classification and prevention and control level selection" to make up for the shortcomings in epidemic risk analysis and judgment. This could provide a reference for city managers to effectively coordinate existing resources, formulate policy, and control the epidemic.

Optimizing two-dose vaccine resource allocation to combat a pandemic in the context of limited supply: The case of COVID-19

The adequate vaccination is a promising solution to mitigate the enormous socio-economic costs of the ongoing COVID-19 pandemic and allow us to return to normal pre-pandemic activity patterns. However, the vaccine supply shortage will be inevitable during the early stage of the vaccine rollout. Public health authorities face a crucial challenge in allocating scarce vaccines to maximize the benefits of vaccination. In this paper, we study a multi-period two-dose vaccine allocation problem when the vaccine supply is highly limited. To address this problem, we constructed a novel age-structured compartmental model to capture COVID-19 transmission and formulated as a nonlinear programming (NLP) model to minimize the total number of deaths in the population. In the NLP model, we explicitly take into account the two-dose vaccination procedure and several important epidemiologic features of COVID-19, such as pre-symptomatic and asymptomatic transmission, as well as group heterogeneity in susceptibility, symptom rates, severity, etc. We validated the applicability of the proposed model using a real case of the 2021 COVID-19 vaccination campaign in the Midlands of England. We conducted comparative studies to demonstrate the superiority of our method. Our numerical results show that prioritizing the allocation of vaccine resources to older age groups is a robust strategy to prevent more subsequent deaths. In addition, we show that releasing more vaccine doses for first-dose recipients could lead to a greater vaccination benefit than holding back second doses. We also find that it is necessary to maintain appropriate non-pharmaceutical interventions (NPIs) during the vaccination rollout, especially in low-resource settings. Furthermore, our analysis indicates that starting vaccination as soon as possible is able to markedly alleviate the epidemic impact when the vaccine resources are limited but are currently available. Our model provides an effective tool to assist policymakers in developing adaptive COVID-19 likewise vaccination strategies for better preparedness against future pandemic threats.

Effects of infection fatality ratio and social contact matrices on vaccine prioritization strategies

Effective strategies of vaccine prioritization are essential to mitigate the impacts of severe infectious diseases. We investigate the role of infection fatality ratio (IFR) and social contact matrices on vaccination prioritization using a compartmental epidemic model fueled by real-world data of different diseases and countries. Our study confirms that massive and early vaccination is extremely effective to reduce the disease fatality if the contagion is mitigated, but the effectiveness is increasingly reduced as vaccination beginning delays in an uncontrolled epidemiological scenario. The optimal and least effective prioritization strategies depend non-linearly on epidemiological variables. Regions of the epidemiological parameter space, in which prioritizing the most vulnerable population is more effective than the most contagious individuals, depend strongly on the IFR age profile being, for example, substantially broader for COVID-19 in comparison with seasonal influenza. Demographics and social contact matrices deform the phase diagrams but do not alter their qualitative shapes.

Optimizing Spatio-Temporal Allocation of the COVID-19 Vaccine Under Different Epidemiological Landscapes

An efficient and safe vaccine is expected to allow people to return to normal life as soon as possible. However, vaccines for new diseases are likely to be in short supply during the initial deployment due to narrow production capacity and logistics. There is an urgent need to optimize the allocation of limited vaccines to improve the population effectiveness of vaccination. Existing studies mostly address a single epidemiological landscape. The robustness of the effectiveness of other proposed strategies is difficult to guarantee under other landscapes. In this study, a novel vaccination allocation model based on spatio-temporal heterogeneity of epidemiological landscapes is proposed. This model was combined with optimization algorithms to determine the near-optimal spatio-temporal allocation for vaccines with different effectiveness and coverage. We fully simulated the epidemiological landscapes during vaccination, and then minimized objective functions independently under various epidemiological landscapes and degrees of viral transmission. We find that if all subregions are in the middle or late stages of the pandemic, the difference between the effectiveness of the near-optimal and pro-rata strategies is very small in most cases. In contrast, under other epidemiological landscapes, when minimizing deaths, the optimizer tends to allocate the remaining doses to sub-regions with relatively higher risk and expected coverage after covering the elderly. While to minimize symptomatic infections, allocating vaccines first to the higher-risk sub-regions is near-optimal. This means that the pro-rata allocation is a good option when the subregions are all in the middle to late stages of the pandemic. Moreover, we suggest that if all subregions are in the period of rapid virus transmission, vaccines should be administered to older adults in all subregions simultaneously, while when the epidemiological dynamics of the subregions are significantly different, priority can be given to older adults in subregions that are still in the early stages of the pandemic. After covering the elderly in the region, high-risk sub-regions can be prioritized.

Mutation induced infection waves in diseases like COVID-19

After more than 6 million deaths worldwide, the ongoing vaccination to conquer the COVID-19 disease is now competing with the emergence of increasingly contagious mutations, repeatedly supplanting earlier strains. Following the near-absence of historical examples of the long-time evolution of infectious diseases under similar circumstances, models are crucial to exemplify possible scenarios. Accordingly, in the present work we systematically generalize the popular susceptible-infected-recovered model to account for mutations leading to repeatedly occurring new strains, which we coarse grain based on tools from statistical mechanics to derive a model predicting the most likely outcomes. The model predicts that mutations can induce a super-exponential growth of infection numbers at early times, which self-amplify to giant infection waves which are caused by a positive feedback loop between infection numbers and mutations and lead to a simultaneous infection of the majority of the population. At later stages-if vaccination progresses too slowly-mutations can interrupt an ongoing decrease of infection numbers and can cause infection revivals which occur as single waves or even as whole wave trains featuring alternative periods of decreasing and increasing infection numbers. This panorama of possible mutation-induced scenarios should be tested in more detailed models to explore their concrete significance for specific infectious diseases. Further, our results might be useful for discussions regarding the importance of a release of vaccine-patents to reduce the risk of mutation-induced infection revivals but also to coordinate the release of measures following a downwards trend of infection numbers.

COVID-19 waves: variant dynamics and control

The waves of COVID-19 infections driven by its variants continue to nullify the success we achieved through efficacious vaccines, social restrictions, testing and quarantine policies. This paper models the two major variants-driven waves by two sets of susceptible-infected-quarantined-recovered-vaccinated-deceased coupled dynamics that are modulated by the three main interventions: vaccination, quarantine and restrictions. This \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$SI^2Q^2R^2VD$$\end{document}SI2Q2R2VD system is used to demonstrate that the second major novel coronavirus wave in the US is caused by the delta variant and the corresponding rapid surge in infectious cases is driven by the unvaccinated pool of the populace. Next, a feedback control based planned vaccination strategy is derived and is shown to be able to suppress the surge in infections effectively.