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(MENAFN – The Conversation) Several COVID-19 vaccines are in an advanced stage of clinical trials. So the discussion is shifting to who should get these vaccines first if their use is approved. Today we discuss two options. One is to prioritize children. This article first looks at the benefits of vaccinating older people.
While we await further results from the phase 3 studies, it is clear that the supply of any potential COVID vaccine would initially be limited.
Local authorities will need to prioritize distribution to specific groups, at least initially. So how could they make these decisions?
The general consensus is that people with a very high risk of exposure to COVID, such as workers in frontline health and quarantine facilities, should be first.
Less clear is the question of who should be next. This group could include people with occupational, demographic, or health characteristics that put them at high risk of exposure or serious illness.
After a national cabinet meeting on Friday, the federal government indicated that the elderly and vulnerable people would be a priority group.
That’s why prioritizing older people to get their first COVID vaccines is a good idea.
First, a little background
Vaccines work in many different ways, providing benefits to the individual and the community.
An obvious individual advantage is that vaccines can prevent infection in the person being vaccinated. But vaccines can also reduce the amount of virus a person produces if they end up getting infected. This can reduce serious illnesses and reduce their likelihood of passing the virus to others.
All this leads to benefits for the community. If vaccine uptake is high enough and transmission is reduced, our collective (or herd) immunity can be used as an emergency fire. It blocks the transmission routes of the virus and protects vulnerable people from infection, even when these people are not vaccinated.
Here’s what happens when you don’t vaccinate versus when you do, if we were to have a vaccine that was 66% effective. Figures turning red catch COVID-19. Author provided
Serious illness due to COVID is a critical health problem, with the potential to put significant stress on health systems and resources. But if the supply of vaccines is limited, we:
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directly reduce serious illness by giving the vaccine to people most at risk, such as the elderly
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indirectly reduce severe illness by vaccinating people who are most likely to get sick and transmit the virus, such as certain groups of young people
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use a mix of both strategies?
The question is, how can a limited supply of vaccine have a greater impact?
Read More: The 90% effectiveness for Pfizer’s COVID-19 mRNA vaccine is amazing. But we have to wait for the full data
Vaccines and the elderly
As we age, our immune cells can become more difficult to activate, in response to the natural aging process or other factors such as chronic inflammation. As a result, vaccines often protect neither the elderly nor the young.
Importantly, a Phase 1 study with a BioNTech / Pfizer COVID vaccine candidate showed that the size of the immune response was lower in older people, which may suggest reduced protection.
For this reason, the public might think that prioritizing vaccines for older people is a bad idea. Why give a vaccine to people where it won’t work as well? But we should explore older people as a priority group for several reasons.
First, older people are bearing the brunt of severe COVID disease. In Australia, nearly half of severe cases requiring intensive care and over 90% of deaths were people over the age of 65.
Second, a potential vaccine may not protect even in older people, but it should protect to some extent. For example, the flu vaccine provides 60-70% protection in the general community, dropping to 30-40% in people over the age of 65, but even at that rate it protects a sizeable number of older people.
Third, if a potential vaccine does not prevent infection, it could still reduce severe disease. For example, in one study, the flu shot reduced the rate of serious illness in vaccinated people by 23%, regardless of age group.
A modest improvement in cases or severe illness in older people could have a large impact on the overall burden of disease and death.
In particular, aged care facilities should be considered a top priority. This environment is high-risk, as it combines people at very high risk of serious illness and high-density housing. Vaccinating aged care personnel could prevent the virus from penetrating and vaccinating residents could minimize the consequences if it did.
Read More: 5 Ways Our Immune Responses To COVID Vaccines Are Unique
Finally, some vaccines can work well in older people. For example, the Shingrix vaccine stunned the research community in 2015 by demonstrating over 90% protection against shingles in older people – a huge improvement over the previous Zostavax vaccine which only provided 50% protection.
Although the initial supply will be limited, we may have access to more COVID vaccines, which could allow us to prioritize potent vaccines for older people.
Big decisions make a village
In any scenario, addressing complex vaccine distribution issues will require specialist knowledge from many disciplines.
We need to understand how the virus spreads in a given population, how the vaccine works in different groups within that population, who might be hesitant about the vaccine, how we can administer the vaccine to a wide variety of people, and many other factors.
Older people are more likely to get seriously ill if they contract the coronavirus. Shutterstock
Importantly, we are still learning about this virus. It behaves differently in different communities, due to different environments, demographics, biology and behaviors. Strategies can differ in different regions and must adapt to our evolving understanding of the virus. There will be no “one size fits all” approach.
It is also vital to keep in mind that a vaccine will not be a silver bullet. Vaccines are not 100% protective and will take time to launch. Public health measures such as rigorous testing, hand washing, wearing masks and a level of social distancing will remain important for some time.
There will be difficult and controversial decisions for initial access to COVID vaccines, but ultimately the supply of vaccines will become less limited. It is important to remember that we all benefit collectively by leading certain groups to the front of the vaccine queue.
Learn more: Creating a COVID-19 vaccine is just the first step. It will take years to produce and distribute
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