scholarly journals Decline in Uptake of Childhood Vaccinations in a Tertiary Hospital in Northern Ghana during the COVID-19 Pandemic

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Kingsley Appiah Bimpong ◽  
Benjamin Demah Nuertey ◽  
Anwar Sadat Seidu ◽  
Stephanie Ajinkpang ◽  
Alhassan Abdul-Mumin
Keyword(s):  
Healthcare Providers ◽  
Tertiary Hospital ◽  
Childhood Vaccination ◽  
Northern Ghana ◽  
Middle Income ◽  
Vaccine Preventable Diseases ◽  
Childhood Immunizations ◽  
Child Welfare Clinic ◽  
Modelling Studies ◽  
The Impact

At the beginning of the COVID-19 pandemic, early modelling studies estimated a reduction in childhood vaccinations in low- and middle-income countries. Regular provision of both curative and preventive services such as antenatal care and childhood immunizations has been negatively affected since the onset of the pandemic. Our study was aimed at examining the impact that the pandemic had on childhood vaccination services at the Tamale Teaching Hospital (TTH). A mixed methods study design was employed for the study, which was conducted at the Child Welfare Clinic (CWC) of the TTH. With quantitative approach, we retrospectively looked at the uptake of the various vaccines during the pandemic era, defined as the period between 1st March 2020 and 28th February, 2021, and the prepandemic era defined as the period 1st March 2019 to 29th February, 2020. The qualitative approach was used to understand the perspective of five healthcare providers at the CWC and the four caregivers of children who have missed a vaccine or delayed in coming, on the factors accounting for any observed change. Data analysis was done using Microsoft Excel 2016 and thematic content analysis. Quantitative data were presented in frequencies, percentages, and line graphs. With the exception of the Measles Rubella (MR) 2 vaccine, we observed a decline ranging from 47% (2298) to 10.5% (116), with the greatest decline seen in the BCG and the least decline seen in the MR1 vaccine. The month of May 2020 saw the greatest decline, that is, 70.6% (813). A decline of 38.3% (4473) was noted when comparison was made between the designated prepandemic and pandemic eras, for all the vaccines in our study. Fear of COVID-19 infection and misinformation were commonly given as reasons for the decline. Catch-up immunization schedule should be instituted to curtail possible future outbreaks of vaccine-preventable diseases.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals “Burnt by the scorching sun”: climate-induced livelihood transformations, reproductive health, and fertility trajectories in drought-affected communities of Zambia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joseph G. Rosen ◽  
Drosin Mulenga ◽  
Lyson Phiri ◽  
Natasha Okpara ◽  
Caila Brander ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Healthcare Providers ◽  
Adult Women ◽  
Middle Income ◽  
Civic Leaders ◽  
Household Resources ◽  
Income Sources ◽  
Climate Resilience ◽  
Female Headed Households ◽  
The Impact

Abstract Background Climate-induced disruptions like drought can destabilize household and community livelihoods, particularly in low- and middle-income countries. This qualitative study explores the impact of severe and prolonged droughts on gendered livelihood transitions, women’s social and financial wellbeing, and sexual and reproductive health (SRH) outcomes in two Zambian provinces. Methods In September 2020, in-depth interviews (n = 20) and focus group discussions (n = 16) with 165 adult women and men in five drought-affected districts, as well as key informant interviews (n = 16) with civic leaders and healthcare providers, were conducted. A team-based thematic analysis approach, guided by the Framework Method, was used to code transcript text segments, facilitating identification and interpretation of salient thematic patterns. Results Across districts, participants emphasized the toll drought had taken on their livelihoods and communities, leaving farming households with reduced income and food, with many turning to alternative income sources. Female-headed households were perceived as particularly vulnerable to drought, as women’s breadwinning and caregiving responsibilities increased, especially in households where women’s partners out-migrated in search of employment prospects. As household incomes declined, women and girls’ vulnerabilities increased: young children increasingly entered the workforce, and young girls were married when families could not afford school fees and struggled to support them financially. With less income due to drought, many participants could not afford travel to health facilities or would resort to purchasing health commodities, including family planning, from private retail pharmacies when unavailable from government facilities. Most participants described changes in fertility intentions motivated by drought: women, in particular, expressed desires for smaller families, fearing drought would constrain their capacity to support larger families. While participants cited some ongoing activities in their communities to support climate change adaptation, most acknowledged current interventions were insufficient. Conclusions Drought highlighted persistent and unaddressed vulnerabilities in women, increasing demand for health services while shrinking household resources to access those services. Policy solutions are proposed to mitigate drought-induced challenges meaningfully and sustainably, and foster climate resilience.

scholarly journals Prevalence of neural tube defect and hydrocephalus in Northern Ghana

2017 ◽  
Vol 6 (1) ◽  
pp. 18-23
Author(s):  
A. Alhassan ◽  
A. Adam ◽  
D. Nangkuu
Keyword(s):  
Neural Tube ◽  
Neural Tube Defects ◽  
Neural Tube Defect ◽  
Case Fatality ◽  
Tertiary Hospital ◽  
Northern Ghana ◽  
Biomedical Sciences ◽  
Middle Income ◽  
Female Ratio ◽  
Low Middle Income Countries

Neural tube defects (NTDs) are congenital anomalies of the central nervous system (CNS) which affects approximately one in every thousand pregnancies. The estimates, however, varies from country to country with countries implementing national programmes on folic acid fortification recording lower estimates. Neural tube defects are a common cause of morbidity and mortality especially in low-middle income countries such as Ghana. The study was conducted to determine the prevalence of neural tube defect and hydrocephalus in the only tertiary hospital in northern Ghana. This was a 4-year retrospective study from January 2010 to December 2014. Data regarding the age, sex, clinical diagnosis, and treatment outcomes were all retrieved from the registry of medical records using a simple data form designed for this study. During the study period, there were 35,426 deliveries at the facility with 57 cases of neural tube defects, thus giving a prevalence of 1.6 per 1000 births. They were more males than females with a male: female ratio of 2.4:1. All cases were diagnosed at birth. All the cases reported in this study were open neural tube defect (NTD). The most common defect was hydrocephalus occurring in 33 patients representing 57.9%, with spinal bifida occurring in 21 patients representing 38.6%. Encephalocele or cranium bifida occurred in only 5.3% (3 patients). Among the spinal bifida cases, myelomeningocele occurred in 13 patients (59.1%), with meningocele occurring in 8 patients (40.9%). Case fatality was about 15% of diagnosed cases. The prevalence of NTDs in this study is relatively high compared to earlier studies but, is consistent with other findings in the subregion. Prenatal screening and diagnosis are highly recommended since most women undergo routine ultrasonography as part of antenatal service.Journal of Medical and Biomedical Sciences (2017) 6(1), 18-23Keywords: neural tube defect, prevalence, spinal bifida, Northern Ghana

scholarly journals Mobile nudges and financial incentives to improve coverage of timely neonatal vaccination in rural areas (GEVaP trial): A 3-armed cluster randomized controlled trial in Northern Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0247485
Author(s):  
Gillian Levine ◽  
Amadu Salifu ◽  
Issah Mohammed ◽  
Günther Fink
Keyword(s):  
Mobile Phone ◽  
Vaccination Coverage ◽  
Childhood Vaccination ◽  
Northern Ghana ◽  
Voice Call ◽  
Infant Vaccination ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Voice Calls ◽  
The Impact

Background Despite progress in vaccination coverage, timeliness of childhood vaccination remains a challenge in many settings. We aimed to assess if mobile phone-based reminders and incentives to health workers and caregivers could increase timely neonatal vaccination in a rural, low-resource setting. Methods We conducted an open-label cluster randomized controlled 1:1:1 trial with three arms in 15 communities in Northern Ghana. Communities were randomized to 1) a voice call reminder intervention; 2) a community health volunteer (CHV) intervention with incentivized rewards; 3) control. In the voice call reminder arm, a study staff member made voice calls to mothers shortly after birth to encourage vaccination and provide personalized information about available vaccination services. In the incentive arm, CHVs promoted infant vaccination and informed women with recent births about available vaccination opportunities. Both CHVs and women were provided small monetary incentives for on-time early infant vaccination in this arm, delivered using mobile phone-based banking applications. No study activities were conducted in control communities. A population-based survey compared vaccination coverage across arms in the pre-intervention and intervention periods. The primary endpoint was completion of at least one dose of Polio vaccine within 14 days of life and BCG vaccination within 28 days of life. Results Six-hundred ninety births were identified; 106, 88, and 88 from pre-intervention and 150, 135, and 123 in the intervention period, in the control, voice call reminder and CHV incentive arms, respectively. In adjusted intent-to-treat analysis, voice call reminders were associated with 10.5 percentage point (95% CI: 4.0, 17.1) higher coverage of on-time vaccination, while mobile phone-based incentives were associated with 49.5 percentage point (95% CI: 26.4, 72.5) higher coverage. Conclusion Community-based interventions using mobile phone technologies can improve timely early vaccination coverage. A CHV approach with incentives to community workers and caregivers was a more effective strategy than voice call reminders. The impact of vaccination “nudges” via voice calls may be constrained in settings where network coverage and phone ownership are limited. Trial registration This trial was registered at ClinicalTrials.gov; NCT03797950.

scholarly journals Effectiveness of Mandatory and Incentive-Based Routine Childhood Immunization Programs in Europe: A Systematic Review of the Literature

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1173
Author(s):  
Lidia Kuznetsova ◽  
Giorgio Cortassa ◽  
Antoni Trilla
Keyword(s):  
Vaccine Coverage ◽  
Childhood Vaccination ◽  
World Health ◽  
Childhood Immunization ◽  
Vaccination Programs ◽  
Vaccine Preventable Diseases ◽  
Routine Childhood ◽  
Vaccine Mandates ◽  
Health Organization ◽  
The Impact

There is a lack of comprehensive and systematic data and evidence regarding the effectiveness of mandatory and incentive-based vaccination schemes. The results of such programs in some countries have not been adequately studied. A number of countries have recently introduced tightening vaccination measures, and it is important to analyze and assess the results of these programs. The unprecedented situation due to the COVID-19 pandemic and mass vaccination made the topic of the effectiveness of vaccination policies and mandates even more relevant. The aim of the study is to assess childhood vaccination programs implemented in selected countries. The study focuses on initiatives implemented in the European Region of the World Health Organization (WHO). A total of 466 full-text articles were assessed for eligibility, and 26 articles on seven countries were included in the synthesis. Additionally, we obtained and performed an analysis of data on the impact of COVID-19 on vaccine coverage and incidence of vaccine-preventable diseases, and the implementation of vaccine mandates in the selected countries. The evidence collected and analyzed in this review allowed us to conclude that the introduction of children routine vaccination mandates increases vaccine coverage and reduces the incidence of vaccine-preventable diseases when compared to the situation before the introduction of the mandates.

scholarly journals Estimating the health impact of vaccination against 10 pathogens in 98 low and middle income countries from 2000 to 2030

2019 ◽  
Author(s):  
Xiang Li ◽  
Christinah Mukandavire ◽  
Zulma M Cucunubá ◽  
Kaja Abbas ◽  
Hannah E Clapham ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Birth Cohort ◽  
Vaccine Coverage ◽  
Health Impact ◽  
Childhood Vaccination ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Years ◽  
The Impact ◽  
Low And Middle Income

AbstractBackgroundThe last two decades have seen substantial expansion of childhood vaccination programmes in low and middle income countries (LMICs). Here we quantify the health impact of these programmes by estimating the deaths and disability-adjusted life years (DALYs) averted by vaccination with ten antigens in 98 LMICs between 2000 and 2030.MethodsIndependent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae, rotavirus, rubella, yellow fever. Using standardized demographic data and vaccine coverage estimates for routine and supplementary immunization activities, the impact of vaccination programmes on deaths and DALYs was determined by comparing model estimates from the no vaccination counterfactual scenario with those from a default coverage scenario. We present results in two forms: deaths/DALYs averted in a particular calendar year, and in a particular annual birth cohort.FindingsWe estimate that vaccination will have averted 69 (2.5-97.5% quantile range 52-88) million deaths between 2000 and 2030 across the 98 countries and ten pathogens considered, 35 (29-45) million of these between 2000-2018. From 2000-2018, this represents a 44% (36-57%) reduction in deaths due to the ten pathogens relative to the no vaccination counterfactual. Most (96% (93-97%)) of this impact is in under-five age mortality, notably from measles. Over the lifetime of birth cohorts born between 2000 and 2030, we predict that 122 (96-147) million deaths will be averted by vaccination, of which 58 (39-75) and 38 (26-52) million are due to measles and Hepatitis B vaccination, respectively. We estimate that recent increases in vaccine coverage and introductions of additional vaccines will result in a 72% (61-79%) reduction in lifetime mortality caused by these 10 pathogens in the 2018 birth cohort.InterpretationIncreases in vaccine coverage and the introduction of new vaccines into LMICs over the last two decades have had a major impact in reducing mortality. These public health gains are predicted to increase in coming decades if progress in increasing coverage is sustained.

scholarly journals COVID-19 impact on routine immunisations for vaccine-preventable diseases: Projecting the effect of different routes to recovery

2022 ◽  
Author(s):  
Jaspreet Toor ◽  
Xiang Li ◽  
Mark Jit ◽  
Caroline Trotter ◽  
Susy Echeverria-Londono ◽  
...  
Keyword(s):  
Detrimental Effect ◽  
Routine Immunisation ◽  
Middle Income ◽  
Vaccine Preventable Diseases ◽  
The Road ◽  
Middle Income Countries ◽  
The Past ◽  
Impact Modelling ◽  
Vaccine Impact ◽  
The Impact

Introduction: Over the past two decades, vaccination programmes for vaccine-preventable diseases (VPDs) have expanded across low- and middle-income countries (LMICs). However, the rise of COVID-19 resulted in global disruption to routine immunisation (RI) activities. Such disruptions could have a detrimental effect on public health, leading to more deaths from VPDs, particularly without mitigation efforts. Hence, as RIs resume, it is important to estimate the effectiveness of different approaches for recovery. Methods: We apply an impact extrapolation method developed by the Vaccine Impact Modelling Consortium to estimate the impact of COVID-19-related disruptions with different recovery scenarios for ten VPDs across 112 LMICs. We focus on deaths averted due to RIs occurring in the years 2020- 2030 and investigate two recovery scenarios relative to a no-COVID-19 scenario. In the recovery scenarios, we assume a 10% COVID-19-related drop in RI coverage in the year 2020. We then linearly interpolate coverage to the year 2030 to investigate two routes to recovery, whereby the immunization agenda (IA2030) targets are reached by 2030 or fall short by 10%. Results: We estimate that falling short of the IA2030 targets by 10% leads to 11.26% fewer fully vaccinated persons (FVPs) and 11.34% more deaths over the years 2020-2030 relative to the noCOVID-19 scenario, whereas, reaching the IA2030 targets reduces these proportions to 5% fewer FVPs and 5.22% more deaths. The impact of the disruption varies across the VPDs with diseases where coverage expands drastically in future years facing a smaller detrimental effect. Conclusion: Overall, our results show that drops in RI coverage could result in more deaths due to VPDs. As the impact of COVID-19-related disruptions is dependent on the vaccination coverage that is achieved over the coming years, the continued efforts of building up coverage and addressing gaps in immunity are vital in the road to recovery.

scholarly journals 1422. Burden of Pertussis in South Korea: Implications for adults

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S718-S718
Author(s):  
Bruce Mungall ◽  
Hyungwoo Kim ◽  
Kyu-Bin Oh
Keyword(s):  
Literature Review ◽  
South Korea ◽  
National Level ◽  
Vaccine Uptake ◽  
Childhood Vaccination ◽  
Vaccine Preventable Diseases ◽  
Vaccination Rates ◽  
Antibody Levels ◽  
The Impact ◽  
Pertussis Epidemiology

Abstract Background There are a limited number of published studies on pertussis disease burden and epidemiology in South Korea, particularly those evaluating the impact in adults. Methods We conducted a systematic literature review on pertussis epidemiology and burden of disease in South Korea. The objective was to highlight evidence gaps which could help improve awareness about pertussis disease in adults in South Korea. Results Of 940 articles published between January 2000 to December 2019, 19 articles provided data for pertussis epidemiology and 9 provided data in adults. Laboratory confirmation rates in adults varied according to methodology, likely influenced by study/sampling variations. Three studies reported serological evidence of infection in adolescents and adults (33-57%). Among cases, the average cough duration was 16.5 days (range 7-30 days) and over 85% of cases presented with paroxysmal cough, while only 25% of cases or less presented with a characteristic whoop or post-tussive vomiting. Importantly, in 4 studies reporting vaccination status, almost all adult cases had no history of pertussis vaccination since childhood. Conclusion Primary childhood vaccination rates in South Korea are among the highest globally, while adult pertussis vaccine uptake appears to be quite low. Our literature review suggests that pertussis is underreported in adults, as evidenced by serology data demonstrating that tetanus antibody levels are low while pertussis toxin antibody levels are relatively high, suggesting continued circulation of community pertussis. These findings highlight the need for strategies such as maternal immunization and decennial revaccination of adults to address the changing epidemiology and waning immunity. Active pertussis testing/reporting and better utilization of adult vaccine registries is required to help provide robust data for vaccine decision-making at the national level. In the current COVID-19 environment, strategies that can reduce clinic or hospital visits will have substantial benefits to authorities managing rapid increases in health care resource utilization, and vaccine preventable diseases provide an easy and immediate target for achieving that goal. Disclosures Bruce Mungall, PhD, the GSK group of companies (Employee, Shareholder) Hyungwoo Kim, MD, MPH, the GSK group of companies (Employee) Kyu-Bin Oh, MD, the GSK group of companies (Employee, Shareholder)

scholarly journals Pattern of Obstetric Clinic Attendance, Deliveries and Neonatal Outcome at a Tertiary Hospital during and after a Free Medical Care Programme

2020 ◽  
pp. 22-31
Author(s):  
P. A. Awoyesuku ◽  
D. A. MacPepple ◽  
B. O. Altraide ◽  
D. H. John ◽  
N. J. Kwosah
Keyword(s):  
Medical Care ◽  
Neonatal Outcome ◽  
Statistical Significance ◽  
Tertiary Hospital ◽  
Population Based ◽  
Clinic Attendance ◽  
Care Programme ◽  
Middle Income ◽  
Significant Difference ◽  
The Impact

Background: Policies and programs aimed at giving access to healthcare free of charge for some segments of the population are increasingly being put in place by low and middle-income countries. The impact of such policies has so far been rather mixed. Objective: This study sought to determine the pattern of obstetrics clinic attendance, deliveries and neonatal outcome during and after a Free Medical Care (FMC) Programme. Was there any significant difference during and after the FMC programme?  Methodology: This was a retrospective population-based study involving the three years of a free medical care programme (2012-2014) and the three years after the programme (2015-2017). Data on antenatal/postnatal clinic attendance, method of deliveries and neonatal outcome were retrieved from the hospital records. The Epi-Info 7 statistical software was used for analysis and statistical significance was set at p<0.05. Results: Mean antenatal attendance was 20763.67±6085.71 and 14269.00±1932.71 during and after the programme respectively, but this difference was not significant (P = 0.143). The mean postnatal attendance of 1457.7±447.69 during and 1025.7±193.52 after was not significant (P=0.200). There was more total number of deliveries during (8596) than after (5989) but this was not significant (P=0.171). There were more operative deliveries during (51.9%) than after (39.3%) and this was significant (P=0.0001). The CS rate was 43.1% with previous CS and CPD both responsible for over 40%. Livebirths were 8,272 (58.8%) during and 5,796 (41.2%) after, which was significant (P=0.0001). There was significant difference (P=0.006) in the macerated stillborn (MSB) rate during (44.2%) and after (55.8%). The stillborn rate was 66.9 during and 98.2 after the programme. Conclusion: There were more clinic attendance and deliveries during the programme, but it was not statistically significant. There was however statistically significant increase in operative delivery, total births and livebirths, and reduced MSB rate during the programme.

scholarly journals Models of COVID-19 vaccine prioritisation: a systematic literature search and narrative review

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Nuru Saadi ◽  
Y-Ling Chi ◽  
Srobana Ghosh ◽  
Rosalind M. Eggo ◽  
Ciara V. McCarthy ◽  
...  
Keyword(s):  
Vaccine Coverage ◽  
Policy Research ◽  
Economic Research ◽  
Ethical Challenge ◽  
National Bureau ◽  
Economic Modelling ◽  
Middle Income ◽  
Middle Income Countries ◽  
Modelling Studies ◽  
The Impact

Abstract Background How best to prioritise COVID-19 vaccination within and between countries has been a public health and an ethical challenge for decision-makers globally. We reviewed epidemiological and economic modelling evidence on population priority groups to minimise COVID-19 mortality, transmission, and morbidity outcomes. Methods We searched the National Institute of Health iSearch COVID-19 Portfolio (a database of peer-reviewed and pre-print articles), Econlit, the Centre for Economic Policy Research, and the National Bureau of Economic Research for mathematical modelling studies evaluating the impact of prioritising COVID-19 vaccination to population target groups. The first search was conducted on March 3, 2021, and an updated search on the LMIC literature was conducted from March 3, 2021, to September 24, 2021. We narratively synthesised the main study conclusions on prioritisation and the conditions under which the conclusions changed. Results The initial search identified 1820 studies and 36 studies met the inclusion criteria. The updated search on LMIC literature identified 7 more studies. 43 studies in total were narratively synthesised. 74% of studies described outcomes in high-income countries (single and multi-country). We found that for countries seeking to minimise deaths, prioritising vaccination of senior adults was the optimal strategy and for countries seeking to minimise cases the young were prioritised. There were several exceptions to the main conclusion, notably that reductions in deaths could be increased if groups at high risk of both transmission and death could be further identified. Findings were also sensitive to the level of vaccine coverage. Conclusion The evidence supports WHO SAGE recommendations on COVID-19 vaccine prioritisation. There is, however, an evidence gap on optimal prioritisation for low- and middle-income countries, studies that included an economic evaluation, and studies that explore prioritisation strategies if the aim is to reduce overall health burden including morbidity.

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