A lab technician oversees the filling and package of vials for the large-scale production of the Oxford-AstraZeneca Covid-19 vaccine candidate at the Italian manufacturing facility of Catalent in Anagni, southeast of Rome, September 11, 2020. AFP
A lab technician oversees the filling and package of vials for the large-scale production of the Oxford-AstraZeneca Covid-19 vaccine candidate at the Italian manufacturing facility of Catalent in Anagni, southeast of Rome, September 11, 2020. AFP
The Oxford vaccine could be among the first to hit the market. Vincenzo Pinzo / AFP
The Oxford vaccine could be among the first to hit the market. Vincenzo Pinzo / AFP
A boy looks at Sinovac Biotech's vaccine candidate at the China International Fair for Trade in Services in Beijing. AFP
A boy looks at Sinovac Biotech's vaccine candidate at the China International Fair for Trade in Services in Beijing. AFP
A technician looks at monkey kidney cells as he makes a test on an experimental vaccine for Covid-19 at Sinovac Biotech facilities in Beijing. AFP
A technician looks at monkey kidney cells as he makes a test on an experimental vaccine for Covid-19 at Sinovac Biotech facilities in Beijing. AFP
A clinical research nurse prepares a Covid-19 vaccine to administer to a volunteer, at a clinic in London. AP
A clinical research nurse prepares a Covid-19 vaccine to administer to a volunteer, at a clinic in London. AP
Peru's President Martin Vizcarra speaks to the press during a visit to the bio-medical department of the Cayetano Heredia National University in Lima, where studies for vaccines against coronavirus are being developed. AFP
Peru's President Martin Vizcarra speaks to the press during a visit to the bio-medical department of the Cayetano Heredia National University in Lima, where studies for vaccines against coronavirus are being developed. AFP
Robyn Porteous, a vaccine trial volunteer, is injected as part of South Africa's human clinical trial at the Wits RHI Shandukani Research Centre in Johannesburg, South Africa. Reuters
Robyn Porteous, a vaccine trial volunteer, is injected as part of South Africa's human clinical trial at the Wits RHI Shandukani Research Centre in Johannesburg, South Africa. Reuters
A nurse inoculates volunteer Ilya Dubrovin, 36, with Russia's new coronavirus vaccine at a clinic in Moscow. AFP
A nurse inoculates volunteer Ilya Dubrovin, 36, with Russia's new coronavirus vaccine at a clinic in Moscow. AFP
Norwegian Prime Minister Erna Solberg (L) and Minister for Development Aid Dag Inge Ulstein (R) participate in a digital meeting with international leaders about a fair global distribution of Covid-19 vaccines at the the Prime Minister's office in Oslo on 10 September 2020. EPA
Norwegian Prime Minister Erna Solberg (L) and Minister for Development Aid Dag Inge Ulstein (R) participate in a digital meeting with international leaders about a fair global distribution of Covid-19 vaccines at the the Prime Minister's office in Oslo on 10 September 2020. EPA
A medic works in a lab during clinical trials for a Covid-19 vaccine at Research Centres of America in Hollywood, Florida. Bloomberg
A medic works in a lab during clinical trials for a Covid-19 vaccine at Research Centres of America in Hollywood, Florida. Bloomberg

Health

The dilemma we face: who should get the Covid-19 vaccine first?

Many countries will prioritise the elderly and vulnerable, but some say that socially active young people and those in the workforce should be first

Daniel Bardsley
Daniel Bardsley

January 18, 2021

  • English
  • Arabic

Latest: UAE allows use of Covid-19 vaccine for children aged 16 and above

As more positive results from clinical trials of vaccines are announced, countries must consider how they can introduce immunisation programmes.

They face a tough choice: start with the elderly and vulnerable, who have high mortality rates but often minimal social interactions.

Or inoculate younger more socially active people – and people in their 20s, 30s and 40s who make up the bulk of the workforce.

Vaccine stockpiles have already been built up but supplies will be limited in the coming months.

Some nations, such as the UK, are prioritising primarily by age, in line with the pattern that mortality rates increase steeply as people get older.

The criteria for vaccination priority should not be those with the highest mortality but those with the highest number of daily person-to-person interactions

Greatest priority is given to older adults in care homes and care home workers, followed by those over 80 and healthcare and social care workers.

It is only when all over-65s have been offered the vaccine that high-risk adults younger than 65 will be included, which could be mid-2021 or later.

According to David Taylor, professor emeritus of pharmaceutical and public health policy at University College London, it is “a sensible way forward” to focus on those at raised risk who can safely be given a vaccine.

“The easiest way to do that is by age. I think it’s a reasonable strategy,” he said.

While there are detail differences among other major European countries, such as Germany, Italy and Spain, they too are also focusing on those most vulnerable because of health conditions or age, plus healthcare workers.

France’s approach is similar but casts a wider net when it comes to people at increased risk because of their occupation.

Their prioritised list includes 23 million people who are elderly or have underlying medical conditions, plus 1.8 million workers in healthcare and related sectors, and 5 million taxi drivers, shop workers, school employees and others who have frequent contact with the public. Taxi drivers are reported to have suffered high mortality early on in the pandemic.

The US Centres for Disease Control suggests that, along with other at-risk groups, members of ethnic minority communities could be prioritised because they have been hit harder by the virus.

Latest research from Khalifa University, however, appears to upend conventional wisdom when it comes to whom vaccination programmes should focus on.

Computer modelling suggests priority should be given to people who have most interactions with others, typically younger individuals, even if they themselves are unlikely to fall seriously ill should they contract the coronavirus.

Delicate balancing act for decision-makers

Under one scenario modelled by the researchers (involving 75 per cent vaccine effectiveness and 80 per cent coverage), prioritising according to the number of interactions a person has cut deaths by 63.5 per cent compared to vaccination without any prioritisation. A refinement of this strategy reduced fatalities by 71.7 per cent.

“The criteria for groups' vaccination priority should not be those with the highest mortality but rather those the highest number of daily person-to-person interactions,” the authors wrote.

The rationale is that vaccinating people who are most likely to interact with others does not only reduce mortality within the vaccinated group (who are at modest risk), but also cuts the number of other people who will be infected by members of this group. This is called the “amplification effect”.

Notably, the results indicate that prioritising those with greatest mortality – the strategy most governments are adopting – results in more deaths than a vaccination programme that does not prioritise any groups. With 75 per cent vaccine effectiveness and 80 per cent coverage, modelling found this approach resulted in an 11.6 per cent increase in deaths compared to no prioritisation.

Published in medRxiv, the findings have yet to be viewed by outside researchers.

World's younger people may 'shun vaccine shots'

Another advantage of focusing initially on younger people may be speed, which could be particularly important in vaccination programmes of the scale being envisaged.

Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter in the UK and consultant in communicable disease control, said that, from his experience in clinics, dealing with older people who are being vaccinated takes longer, potentially reducing throughput.

“It takes time. In an emergency, if you can immunise as many people as you can, it’s a good idea,” he said.

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But he said that prioritising younger people “wouldn’t go down very well”, so a strategy that focuses on “the elderly, the spreaders and the healthcare workers” was likely to be better.

A possible drawback of focusing on younger people may be that they will be less likely to take up the offer of a vaccine. Compulsory vaccination would get around this, but few governments are keen on the idea.

“People at known risk would be very quick to take the vaccine offered, but those with little risk would probably not. Why should they bother if they are not likely to get sick?” said Ian Jones, a professor of virology at the University of Reading in the UK.

Another issue Prof Jones highlighted was the limitations of vaccine supplies, which mean its introduction would have to be staggered, “leaving open the transmission routes for some time” with the approach outlined in the new research.

Like Dr Pankhania, he suggested that leaving out the elderly in early vaccination programmes would be poorly received.

“It would be seen as callous, almost as if you were consigning the older group to the scrap heap,” he said.

Amid starkly divergent views about who to focus on when mass vaccination starts, governments face not just logistical hurdles, but also the challenge of selecting the best strategy.

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Top New Zealand cop on policing the virtual world

New Zealand police began closer scrutiny of social media and online communities after the attacks on two mosques in March, the country's top officer said.

The killing of 51 people in Christchurch and wounding of more than 40 others shocked the world. Brenton Tarrant, a suspected white supremacist, was accused of the killings. His trial is ongoing and he denies the charges.

Mike Bush, commissioner of New Zealand Police, said officers looked closely at how they monitored social media in the wake of the tragedy to see if lessons could be learned.

“We decided that it was fit for purpose but we need to deepen it in terms of community relationships, extending them not only with the traditional community but the virtual one as well," he told The National.

"We want to get ahead of attacks like we suffered in New Zealand so we have to challenge ourselves to be better."

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Uefa Champions League final:

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Children who witnessed blood bath want to help others

Aged just 11, Khulood Al Najjar’s daughter, Nora, bravely attempted to fight off Philip Spence. Her finger was injured when she put her hand in between the claw hammer and her mother’s head.

As a vital witness, she was forced to relive the ordeal by police who needed to identify the attacker and ensure he was found guilty.

Now aged 16, Nora has decided she wants to dedicate her career to helping other victims of crime.

“It was very horrible for her. She saw her mum, dying, just next to her eyes. But now she just wants to go forward,” said Khulood, speaking about how her eldest daughter was dealing with the trauma of the incident five years ago. “She is saying, 'mama, I want to be a lawyer, I want to help people achieve justice'.”

Khulood’s youngest daughter, Fatima, was seven at the time of the attack and attempted to help paramedics responding to the incident.

“Now she wants to be a maxillofacial doctor,” Khulood said. “She said to me ‘it is because a maxillofacial doctor returned your face, mama’. Now she wants to help people see themselves in the mirror again.”

Khulood’s son, Saeed, was nine in 2014 and slept through the attack. While he did not witness the trauma, this made it more difficult for him to understand what had happened. He has ambitions to become an engineer.

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Know before you go
  • Jebel Akhdar is a two-hour drive from Muscat airport or a six-hour drive from Dubai. It’s impossible to visit by car unless you have a 4x4. Phone ahead to the hotel to arrange a transfer.
  • If you’re driving, make sure your insurance covers Oman.
  • By air: Budget airlines Air Arabia, Flydubai and SalamAir offer direct routes to Muscat from the UAE.
  • Tourists from the Emirates (UAE nationals not included) must apply for an Omani visa online before arrival at evisa.rop.gov.om. The process typically takes several days.
  • Flash floods are probable due to the terrain and a lack of drainage. Always check the weather before venturing into any canyons or other remote areas and identify a plan of escape that includes high ground, shelter and parking where your car won’t be overtaken by sudden downpours.

 

How to join and use Abu Dhabi’s public libraries

• There are six libraries in Abu Dhabi emirate run by the Department of Culture and Tourism, including one in Al Ain and Al Dhafra.

• Libraries are free to visit and visitors can consult books, use online resources and study there. Most are open from 8am to 8pm on weekdays, closed on Fridays and have variable hours on Saturdays, except for Qasr Al Watan which is open from 10am to 8pm every day.

• In order to borrow books, visitors must join the service by providing a passport photograph, Emirates ID and a refundable deposit of Dh400. Members can borrow five books for three weeks, all of which are renewable up to two times online.

• If users do not wish to pay the fee, they can still use the library’s electronic resources for free by simply registering on the website. Once registered, a username and password is provided, allowing remote access.

• For more information visit the library network's website.

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