Guiding equitable prioritisation of COVID-19 vaccine distribution and strategic deployment in South Africa to enhance effectiveness and access to vulnerable communities and prevent waste
SAMJ South African Medical Journal
; 112(2):87-95, 2022.
Article
in English
| CAB Abstracts | ID: covidwho-1744689
ABSTRACT
Background. In South Africa (SA), >2.4 million cases of COVID-19 and >72 000 deaths were recorded between March 2020 and 1 August 2021, affecting the country's 52 districts to various extents. SA has committed to a COVID-19 vaccine roll-out in three phases, prioritising frontline workers, the elderly, people with comorbidities and essential workers. However, additional actions will be necessary to support efficient allocation and equitable access for vulnerable, access-constrained communities. Objectives. To explore various determinants of disease severity, resurgence risk and accessibility in order to aid an equitable, effective vaccine roll-out for SA that would maximise COVID-19 epidemic control by reducing the number of COVID-19 transmissions and resultant deaths, while at the same time reducing the risk of vaccine wastage. Methods. For the 52 districts of SA, 26 COVID-19 indicators such as hospital admissions, deaths in hospital and mobility were ranked and hierarchically clustered with cases to identify which indicators can be used as indicators for severity or resurgence risk. Districts were then ranked using the estimated COVID-19 severity and resurgence risk to assist with prioritisation of vaccine roll-out. Urban and rural accessibility were also explored as factors that could limit vaccine roll-out in hard-to-reach communities. Results. Highly populated urban districts showed the most cases. Districts such as Buffalo City, City of Cape Town and Nelson Mandela Bay experienced very severe first and second waves of the pandemic. Districts with high mobility, population size and density were found to be at highest risk of resurgence. In terms of accessibility, we found that 47.2% of the population are within 5 km of a hospital with 50 beds, and this percentage ranged from 87.0% in City of Cape Town to 0% in Namakwa district. Conclusions. The end goal is to provide equal distribution of vaccines proportional to district populations, which will provide fair protection. Districts with a high risk of resurgence and severity should be prioritised for vaccine roll-out, particularly the major metropolitan areas. We provide recommendations for allocations of different vaccine types for each district that consider levels of access, numbers of doses and cold-chain storage capability.
Prion, Viral, Bacterial and Fungal Pathogens of Humans [VV210]; Host Resistance and Immunity [HH600]; Health Services [UU350]; human diseases; viral diseases; coronavirus disease 2019; pandemics; public health; vaccines; vaccination; immunization; health protection; disease prevention; resource allocation; access; health care; health services; community health; health care workers; elderly; comorbidity; workers; disease transmission; mortality; hospital admission; urban areas; rural areas; epidemiology; distance travelled; quality of care; immune sensitization; man; Severe acute respiratory syndrome coronavirus 2; South Africa; Homo; Hominidae; primates; mammals; vertebrates; Chordata; animals; eukaryotes; Severe acute respiratory syndrome-related coronavirus; Betacoronavirus; Coronavirinae; Coronaviridae; Nidovirales; positive-sense ssRNA Viruses; ssRNA Viruses; RNA Viruses; viruses; Anglophone Africa; Africa; Commonwealth of Nations; high Human Development Index countries; Southern Africa; Africa South of Sahara; upper-middle income countries; SARS-CoV-2; subsaharan Africa; viral infections; aged; elderly people; older adults; senior citizens; death rate
Full text:
Available
Collection:
Databases of international organizations
Database:
CAB Abstracts
Type of study:
Experimental Studies
Topics:
Vaccines
Language:
English
Journal:
SAMJ South African Medical Journal
Year:
2022
Document Type:
Article
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