The COVID-19 vaccine: who gets it first?
19 December 2020
Key points
- The NHS’s vaccination campaign hopefully marks the beginning of the end of the pandemic. However, as vaccines will be in short supply for months, government has had to make decisions about who to vaccinate first.
- The current approach prioritises reducing mortality over reducing transmission and therefore targets vaccination at those most likely to die as a result of COVID-19. Because age is the primary predictor of COVID-19 mortality, this means mainly targeting older people. It would be necessary to vaccinate around 32 times more 60–64 year olds than those older than 90 years old to save a life, or six times as many to save one year of life. Front-line health and social care workers and the clinically vulnerable will also be vaccinated.
- But there are other factors that affect COVID-19 mortality, and accounting for these in how vaccines are targeted could save more lives. Programmes could take account of the higher death rate among men or ethnic minority communities. They could focus on areas of high prevalence or selectively target people who have not already had COVID-19. They could also consider broader questions of fairness – such as whether essential workers, who may not have any choice but to risk exposure to the virus, should be vaccinated ahead of those more able to shield.
- It is one thing to design an optimal approach to vaccination but quite another to implement it speedily and fairly, in a way acceptable to the public. The government is taking a pragmatic approach to prioritisation. The challenge now is for the NHS to overcome the barriers – logistical and attitudinal – to vaccinating the over 25 million people on the initial priority list.
- Issues around fairness and prioritisation will arise in the months ahead, not only around vaccination but also access to treatment as waiting lists for non-COVID-19 care grow. To maintain public trust and confidence, the government should clearly set out the basis for its decisions, including the trade-offs it has made.
Note: this analysis was published on 19 December 2020. It explores the trade-offs that government will have had to consider in deciding which groups get the coronavirus (COVID-19) vaccine first. It is based on the latest advice from the Joint Committee on Vaccination and Immunisation (JCVI). It does not include any analysis of the speed of vaccine roll-out or the timing of doses. To read the latest NHS advice on the coronavirus vaccine visit the NHS website.
Introduction
The start of the NHS’s vaccination campaign hopefully marks the beginning of the end of a pandemic that has upended all our lives. But vaccines will continue to be in very short supply for months. Some people will need to be vaccinated first, with others to follow. The order in which people get the vaccine matters – there will be people who die in the coming months because others got the vaccine ahead of them.
So, how has it been decided who gets vaccinated first? Who has made the decision and on what basis?
Further reading
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