Who should get the coronavirus vaccine first? France and UK have different answers

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Shortly after Pfizer and BioNTech announced in a press release that their COVID-19 vaccine candidate was over 90% effective, British politicians began discussing an impending deployment – before Christmas, according to the minister of Health Matt Hancock. On the other side of the Channel, France is also preparing to deploy the vaccine, but in a different way.

In the UK, the government has adopted advice from its Joint Committee on Vaccines and Immunization (JCVI) on who should get the vaccine first. If the vaccine was approved, the JCVI proposed a prioritization strategy mainly based on age (starting with the oldest first), as well as health and social workers (see table below ).

Priorities for vaccine deployment in the UK Priorities for vaccine deployment in France
Main similarities
Health care, home and social service workers Everyone 65 years of age and over (starting with older groups) or at higher risk of serious illness and death (for example, chronic kidney disease, immunosuppression, diabetes mellitus controlled, obesity). Healthcare professionals, such as doctors, surgeons, dentists, pharmacists, midwives, nurses and caregivers. Anyone over 65 or with a chronic disease (such as cardiovascular disease, hypertension, diabetes) or obesity.
Key differences
People aged 50 to 65 will have priority after those aged over 65. After health workers, some young workers would also be considered high priority because of their contact with the general public – for example, store workers, school staff, transport staff and reception workers, as well as those who work in confined spaces such as slaughterhouse staff, taxis. drivers, migrant workers and construction crews.

In France, government policy is shaped by several advisory bodies including the Scientific Council and the Analysis, Research and Expertise Committee, which have also published draft guidelines.

While there are some similarities with the UK strategy – such as the high priority given to healthcare workers – there are also substantial differences. A key difference is that the French guidelines prioritize high-risk occupations, including store workers, school staff, transport staff such as taxi drivers, hotel workers and slaughterhouse staff.

Why the different approaches?

In the UK, the JCVI argues that age-based programs are easier to implement and therefore tend to have a higher vaccination rate. Granted, if you pick just one factor, the age is very good because your risk of dying from COVID-19 doubles roughly every five years (as shown in the graph below).


Laurence Roope, Author provided

Beyond age, many other factors have also been found to place a person at a higher risk of death from COVID-19. Having a chronic disease, such as diabetes, roughly equals the risk of being five to ten years older. Assessing a person’s likelihood of contracting severe COVID, using an algorithm that takes into account several risk factors, could help ensure that the vaccine is more precisely targeted to those people likely to benefit the most. in each age group.

There is therefore a trade-off between the potential gains in adopting the use of simple age-based prioritization and greater protection of the most vulnerable from a more targeted approach.

Here we can learn from the evidence about the adoption of the influenza vaccine, which also targets the elderly (over 65). It is important to note that participation is not uniform with a universal age-based program – poorer people are much less likely to be vaccinated. A challenge with the UK strategy will therefore be to find ways to facilitate access by disadvantaged groups to the vaccine, or risk increasing health inequalities.

This is where we come to the French approach of targeting higher risk trades.

During the first wave, deaths from COVID-19 were particularly high in some occupations. As shown in the graph below, some occupations, such as taxi drivers and taxi drivers (which are priority occupations in the proposed French allowance system), have higher death rates than healthcare workers. Notably, many of these workers under 50 are not explicitly mentioned in the UK’s vaccine allocation plans.

Age-standardized death rates for COVID-19 among men aged 20 to 64, comparing London and the rest of England and Wales, between March 9 and May 25, 2020.
Laurence Roope, Author provided

One factor that the French and UK committees must now take into account is that a COVID-19 vaccine is likely to be introduced during the second wave of the pandemic in which there is considerable regional variation in transmission rates. The graph above also shows the differences in death rates in the first wave between London and other areas. Lives could potentially be saved by targeting initial doses of vaccine to areas with the most cases.

Public consultation

Beyond the differences in recommendations, there are differences between the two countries in their approaches to public consultation. Unlike the guidelines for other health technologies, the UK prioritization guidelines have not gone through a formal public consultation process.

On the other hand, the French government is now engaged in a vast process of public consultation to inform the hierarchy. This is in part intended to avoid the low uptake of past immunization programs, such as the 2009 H1N1 pandemic. This process involves including relevant sectors of the population in the design of vaccine allocation strategies, learning from this. that people prefer and use that information to effectively communicate the strategy to the public.

This type of consultation takes time, but a potential benefit is that it helps governments understand what people value. It also helps to further refine prioritization policy and communication strategies, which in turn can increase the likelihood that people will support vaccine allocation guidelines and thereby promote uptake.

It’s clear, even looking at the policies of just two governments, that there are many possible strategies for prioritizing COVID-19 vaccines. As a recent COVID-19 vaccine allocation framework suggests, these strategies can be evaluated against different criteria, potentially with input from the public. While it looks like we have an effective COVID-19 vaccine, it will be a much better thing if we allocate it fairly and efficiently.

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