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Who should get the COVID-19 vaccine first?


By Siddharth Sridhar, clinical assistant professor from the Department of Microbiology, University of Hong Kong

A few days ago, Sophia Chan, the Secretary for Food & Health, announced a preliminary sketch of the government's plan to procure COVID-19 vaccines for Hong Kong.

Details remain to be announced, but a gradual roll-out is expected with the initial target being ~ 3 million individuals in so-called priority groups in early/mid 2021 followed by larger scale vaccinations by end-2021/early-2022.

News of vaccine have given hope towards the fight against Covid. A NHS pharmacy technician is pictured for receiving vaccine training. AP file photo.

The initial groups targeted for vaccination must be needs-based with three objectives: a) protect the most vulnerable people in Hong Kong, b) protect the healthcare system of Hong Kong, and c) keep society functional.

So, who should get the vaccine when it first becomes available? This is a tough question and there are bound to be many different opinions, but I propose the following priority groups:

1. The elderly: there is no doubt that the elderly and individuals with chronic medical conditions are most at risk of COVID-19-related complications. Vaccinating them would protect them and ease burden on healthcare. The difficult part is setting a cut-off age, which would really depend on how many vaccines we have available. Based on census data, there are about ~ 1.4 million people > 65 in HK, so this is a good figure to start.

2. Healthcare workers: healthcare workers are at unique risk of catching COVID-19 as well as passing it on to patients. We have seen multiple outbreaks of COVID-19 in healthcare settings. An effective vaccine will go a long way to keeping our healthcare workers safe. Based on figures from 2018, we have ~ 90,000 healthcare professionals in HK.

3. Individuals in 'high risk occupations': I propose a few high-risk occupations in the chart below. Others may be included based on vaccine availability. Basically, this includes people whose work requires essential overseas/cross-boundary travel as well as staff at airport/port facilities. I find that taxi drivers are a unique risk group in HK and would benefit from vaccination too. Vaccination of old age home staff, of course, is a must.

4. I support vaccinating school-aged children providing that a vaccine is licensed for this age bracket (I expect this to happen by mid-2021). Not everyone agrees with this because kids seldom catch severe COVID-19 and don't seem to be particularly more infectious than adults. However, recurrent school closures have a big impact on their academic and psychological development. School closures are not sustainable and vaccinating our ~ 900,000 school goers would keep our schools running no matter what. Also, vaccinating them provides a double-layer of protection for vulnerable grandparents in the home. Of course, if some other deserving priority group (? individuals < 65 with chronic medical conditions) is clearly defined, vaccines should be given to them first.

The above categories would roughly amount to ~3 million individuals, which fits the amount of two-dose regimen vaccines we can realistically hope to get by mid-2021.

Ultimately, the vaccine should be rolled out to the entire population, but this initial high priority group vaccine drive would already make life much easier.

There's light at the end of the tunnel!

Stay safe and stay hopeful.

The article is first published on the author’s Facebook.


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