WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines

WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines
21 January 2022
An approach to optimize the global impact of COVID-19 vaccines, based on public health goals, global and national equity, and vaccine access and coverage scenarios
Given the urgency and wide-ranging effects of the COVID-19 pandemic, SAGE has developed an approach to help inform deliberation around the range of recommendations that may be appropriate under different epidemiologic and vaccine supply conditions. To assist in developing recommendations for use of vaccines against COVID-19, SAGE proposes a Roadmap for Prioritizing Uses of COVID-19 Vaccines that considers priority populations for vaccination based on epidemiologic setting and vaccine supply scenarios. This Roadmap builds on the WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination.
PDF: https://apps.who.int/iris/rest/bitstreams/1406385/retrieve
This interim guidance constitutes a major revision of the WHO SAGE roadmap for prioritizing uses of COVID-19 vaccines, first issued October 2020, and updated in November 2020 and July 2021. It is based on work conducted by the SAGE Working Group on COVID-19 Vaccines and SAGE members, from October 2021 to January 2022, including consultation with RITAG1 chairs, and dedicated discussions at extraordinary meetings of the Strategic Advisory Group of Experts (SAGE) on Immunization on 7 December 2021 and 19 January 2022 (1).

This revised Roadmap takes into account increasing vaccine availability, vaccine coverage rates, and the evolving epidemiological situation including COVID-19 variants of concern. Scenarios in which vaccination coverage exceeds 50% of the population are considered, as are topics such as vaccine use in children and adolescents and prioritization of additional and booster doses in relation to vaccination coverage rates. To assist countries in developing recommendations for optimized use of vaccines against COVID-19, priority-use groups for vaccination (both primary series and booster doses) are identified based on epidemiological scenarios, public health goals, and vaccine coverage scenarios (in accordance with WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination (2)).

This Roadmap is complementary to the Strategy to achieve global Covid-19 vaccination by mid-2022 (3) issued in September 2021, which was developed by WHO in collaboration with its COVAX partners and key regional and national stakeholders, and which specifies national vaccine coverage categories. The Roadmap emphasizes the importance of prioritizing the distribution of increasingly available vaccine supply to optimize impact on health, socioeconomic conditions, and equity, and focuses on in-country vaccine policies….
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†Priority-use groups: The extent of risk of severe disease and death is the main determinant for assignment of a subgroup (or subpopulation) to a priority-use group. This criterion aligns with a specification of the human well-being principle in the WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccines. In addition, other specifications of that principle, including reducing societal and economic disruption and protecting essential health services, as well as of the national equity and reciprocity principles, are also used to justify assignment of some of the subgroups to a priority-use group.

*Additional dose: Persons with moderate to severe immunocompromising conditions should receive an expanded primary vaccination series through an additional dose about 1–3 months after completion of the primary series (see Interim recommendations for an extended primary series with an additional vaccine dose for COVID-19 vaccination in immunocompromised persons (4). Such persons are also a high priority-use group for a subsequent (booster) dose.

**Booster dose: The optimal interval between completion of a primary series and administration of a booster dose has yet to be determined, and depends on epidemiological setting, vaccine product, targeted age groups, background seroprevalence, and circulation of specific variants of concern. As a general principle, dependent on vaccine product, an interval of 4–6 months since completion of the primary series could be considered for countries experiencing significant loss of vaccine effectiveness against severe disease in the context of an impending or ongoing major surge of cases, while a longer interval could be considered for those countries currently not experiencing, or at low risk of, an increasing incidence of cases.