Given the scarcity of safe and effective COVID-19 vaccines, a chief policy question is how to allocate them among different sociodemographic groups. This paper evaluates COVID-19 vaccine prioritization strategies proposed to date, focusing on their stated goals; the mechanisms through which the selected allocations affect the course and burden of the pandemic; and the main epidemiological, economic, logistical, and political issues that arise when setting the prioritization strategy. The paper uses a simple, age-stratified susceptible-exposed-infectious-recovered model to quantitatively assess the performance of alternative prioritization strategies with respect to avoided deaths, avoided infections, and life-years gained. We demonstrate that prioritizing essential workers is a viable strategy for reducing the number of cases and years of life lost, while the largest reduction in deaths is achieved by prioritizing older adults in most scenarios, even if the vaccine is effective at blocking viral transmission. Uncertainty regarding this property and potential delays in dose delivery reinforce the call for prioritizing older adults. Additionally, we investigate the strength of the equity motive that would support an allocation strategy attaching absolute priority to essential workers for a vaccine that reduces infection-fatality risk.

鉴于安全有效的 COVID-19 疫苗的稀缺，一个主要的政策问题是如何在不同的社会人口群体之间分配疫苗。本文评估了迄今为止提出的 COVID-19 疫苗优先策略，重点关注其既定目标；选定的拨款影响大流行的进程和负担的机制；以及制定优先策略时出现的主要流行病学、经济、后勤和政治问题。该论文使用一个简单的、按年龄分层的易感者-暴露-感染-恢复模型来定量评估替代优先策略在避免死亡、避免感染和获得生命年方面的表现。我们证明，优先考虑必要工作人员是减少病例数量和生命损失年数的可行策略，而在大多数情况下，通过优先考虑老年人来实现最大程度的死亡减少，即使疫苗能够有效阻止病毒传播。这种特性的不确定性和剂量输送的潜在延迟强化了优先考虑老年人的呼声。此外，我们还调查了支持分配策略的股权动机的强度，该策略将绝对优先权放在可降低感染死亡风险的疫苗的必要工人身上。