WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines
The World Health Organization (WHO) has released a revised version (as of March 2023) of their Roadmap for Prioritizing Uses of COVID-19 Vaccines, given the changed nature of global circumstances three years after the start of the COVID-19 pandemic.
Most countries have lifted most or all public health and social measures, and while the virus continues to circulate, the third year of the pandemic has witnesses a significant reduction in hospitalizations as well as admissions to ICU and deaths across all age groups. This can be credited to various factors including rising population level immunity from infection and/or vaccination and earlier testing and access to COVID-19 medications. However, certain subgroups continue to be at higher risk of severe disease and mortality and account for most of the ongoing COVID 19-related mortality; so, even a slight decrease in vaccine effectiveness can translate into a rise in cases of severe disease and death in vulnerable subgroups.
This Roadmap addresses the evolving public health needs at the present time, taking into account Omicron and its sublineages dominating circulation globally and in the context of high population-level immunity. The Roadmap is built on an assumption that the virus will continue to evolve but result in less severe disease, and with potential surges in infections that will require periodic booster doses of the vaccine to protect the high priority groups. Consideration has been given to high population immunity, ample vaccine supply, declining risk of mortality and severe disease, global dominance of Omicron and its subvariants, differential vaccine performance against infection and severe disease outcomes, and post COVID-19 conditions.
Based on an extensive evidence review including systematic reviews and meta-analyses, the Roadmap provides updates on new priority-use groupings (reducing from four to three strata); specific recommendations for primary series and boosters according to priority-use groups; variant-containing vaccines; heterologous schedules; and vaccination during pregnancy.
The roadmap will be further adapted should new variants of concern emerge that do not have characteristics of Omicron, in the event of significant changes in COVID-19 disease epidemiology, or changes in vaccine attributes that are relevant to the roadmap.
How might you be able to utilize this roadmap in your immunization work? After three years of the COVID-19 pandemic, what unanticipated challenges do you face regarding COVID-19 vaccination? How do you balance the need to continue COVID-19 vaccination with the need to strengthen other immunization services?
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