Modeling geographic vaccination strategies for COVID-19 in Norway
Authors: Chan Louis Yat Hin , Rø Gunnar , Midtbø Jørgen Eriksson , Di Ruscio Francesco , Watle Sara Sofie Viksmoen , Juvet Lene Kristine , Littmann Jasper , Aavitsland Preben , Nygård Karin Maria , Berg Are Stuwitz , Bukholm Geir , Kristoffersen Anja Bråthen , Engø-Monsen Kenth , Engebretsen Solveig , Swanson David , Palomares Alfonso Diz-Lois , Lindstrøm Jonas Christoffer , Frigessi Arnoldo , de Blasio Birgitte Freiesleben 
Published: August 2023

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Vaccination was a key intervention in controlling the COVID-19 pandemic globally. In early 2021, Norway faced significant regional variations in COVID-19 incidence and prevalence, with large differences in population density, necessitating efficient vaccine allocation to reduce infections and severe outcomes. This study explored alternative vaccination strategies to minimize health outcomes (infections, hospitalizations, ICU admissions, deaths) by varying regions prioritized, extra doses prioritized, and implementation start time.

Using two models (individual-based and meta-population), we simulated COVID-19 transmission during the primary vaccination period in Norway, covering the first 7 months of 2021. We investigated alternative strategies to allocate more vaccine doses to regions with a higher force of infection. We also examined the robustness of our results and highlighted potential structural differences between the two models.

Our findings suggest that early vaccine prioritization could reduce COVID-19 related health outcomes by 8% to 20% compared to a baseline strategy without geographic prioritization. For minimizing infections, hospitalizations, or ICU admissions, the best strategy was to initially allocate all available vaccine doses to fewer high-risk municipalities, comprising approximately one-fourth of the population. For minimizing deaths, a moderate level of geographic prioritization, with approximately one-third of the population receiving doubled doses, gave the best outcomes by balancing the trade-off between vaccinating younger people in high-risk areas and older people in low-risk areas.

The actual strategy implemented in Norway was a two-step moderate level aimed at maintaining the balance and ensuring ethical considerations and public trust. However, it did not offer significant advantages over the baseline strategy without geographic prioritization. Earlier implementation of geographic prioritization could have more effectively addressed the main wave of infections, substantially reducing the national burden of the pandemic.

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Author summary

We utilized two geographic-age-structured models (an individual-based model and a meta-population model) to conduct a scenario-based analysis aimed at evaluating strategies for geographic prioritization of COVID-19 vaccines in Norway. By reconstructing the dynamics of COVID-19 transmission from January to July of 2021, we compared various alternative vaccination strategies through model simulations, given the limited number of vaccine doses. We found that prioritization of vaccines based on geographic location, alongside considering age, was preferable to a baseline strategy without geographic prioritization. We assessed the selection of which municipalities to prioritize and the degree of prioritization they should receive. Our findings indicated that optimal strategies depended on whether the aim was to minimize infections, hospitalizations, ICU admissions, or deaths. Trade-offs in infection growth between municipalities and subsequent risk-class allocations (such as age groups) were the primary factors influencing optimal vaccine allocation. Furthermore, we found that earlier implementation of most geographic prioritization strategies was advantageous in reducing the overall burden of COVID-19.