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. 2020 Dec 15:371:m4704.
doi: 10.1136/bmj.m4704.

Global, regional, and national estimates of target population sizes for covid-19 vaccination: descriptive study

Wei Wang  1 , Qianhui Wu  1 , Juan Yang  1 , Kaige Dong  1 , Xinghui Chen  1 , Xufang Bai  1 , Xinhua Chen  1 , Zhiyuan Chen  1 , Cécile Viboud  2 , Marco Ajelli  3   4 , Hongjie Yu  1
Affiliations

Global, regional, and national estimates of target population sizes for covid-19 vaccination: descriptive study

Wei Wang et al. BMJ. .

Abstract

Objective: To provide global, regional, and national estimates of target population sizes for coronavirus disease 2019 (covid-19) vaccination to inform country specific immunisation strategies on a global scale.

Design: Descriptive study.

Setting: 194 member states of the World Health Organization.

Population: Target populations for covid-19 vaccination based on country specific characteristics and vaccine objectives (maintaining essential core societal services; reducing severe covid-19; reducing symptomatic infections and stopping virus transmission).

Main outcome measure: Size of target populations for covid-19 vaccination. Estimates use country specific data on population sizes stratified by occupation, age, risk factors for covid-19 severity, vaccine acceptance, and global vaccine production. These data were derived from a multipronged search of official websites, media sources, and academic journal articles.

Results: Target population sizes for covid-19 vaccination vary markedly by vaccination goal and geographical region. Differences in demographic structure, presence of underlying conditions, and number of essential workers lead to highly variable estimates of target populations at regional and country levels. In particular, Europe has the highest share of essential workers (63.0 million, 8.9%) and people with underlying conditions (265.9 million, 37.4%); these two categories are essential in maintaining societal functions and reducing severe covid-19, respectively. In contrast, South East Asia has the highest share of healthy adults (777.5 million, 58.9%), a key target for reducing community transmission. Vaccine hesitancy will probably impact future covid-19 vaccination programmes; based on a literature review, 68.4% (95% confidence interval 64.2% to 72.6%) of the global population is willing to receive covid-19 vaccination. Therefore, the adult population willing to be vaccinated is estimated at 3.7 billion (95% confidence interval 3.2 to 4.1 billion).

Conclusions: The distribution of target groups at country and regional levels highlights the importance of designing an equitable and efficient plan for vaccine prioritisation and allocation. Each country should evaluate different strategies and allocation schemes based on local epidemiology, underlying population health, projections of available vaccine doses, and preference for vaccination strategies that favour direct or indirect benefits.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the National Science Fund for Distinguished Young Scholars, Key Emergency Project of Shanghai Science and Technology Committee, and National Science and Technology Major Project of China for the submitted work; MA has received research funding from Seqirus and HY has received research funding from Sanofi Pasteur, GlaxoSmithKline, Yichang HEC Changjiang Pharmaceutical Company, and Shanghai Roche Pharmaceutical Company. None of those research funding is related to covid-19. All other authors report no competing interests.

Figures

Fig 1
Fig 1
Priority groups for covid-19 vaccination. Covid-19=coronavirus disease 2019; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2
Fig 2
Fig 2
Global estimates of target population sizes for covid-19 vaccination by goal of vaccination programmes. Covid-19=coronavirus disease 2019
Fig 3
Fig 3
Geographical distribution of member states by World Health Organization region
Fig 4
Fig 4
Regional estimates of target population sizes for covid-19 vaccination by goal of vaccination programmes. Covid-19=coronavirus disease 2019
Fig 5
Fig 5
Upper panel: regional estimates of number of essential workers who are critical to maintaining a functional society. Middle panel: regional estimates of number of vulnerable people to be vaccinated to reduce severe covid-19. Lower panel: regional estimates of number of people that need to be vaccinated to contain transmission. Covid-19=coronavirus disease 2019
Fig 6
Fig 6
Estimates of target population sizes for covid-19 vaccination programmes in 104 countries with robust data on occupation and high risk groups by goal of vaccination programme. Upper panel: target populations to maintain essential core societal services; middle panel: target populations to reduce severe covid-19; lower panel: target populations to reduce symptomatic infections and stop virus transmission. Empty cells represent lack of data on target populations. Covid-19=coronavirus disease 2019
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