Why we should prioritise older people when we get a COVID vaccine

Several vaccines are in the late stage of clinical trials. Who should get them first?

mature man gets a vaccination injection

Kylie Quinn, RMIT University

Several COVID-19 vaccines are in late-stage clinical trials. So, discussion is turning to who should receive these vaccines first, should they be approved for use. This article looks at the benefits of vaccinating older people first.

While we wait for further results from phase 3 trials, it’s clear that supply of any potential COVID vaccine would initially be limited.

Local authorities will need to prioritise distribution to specific groups, at least at first. So how might they make these decisions?

The general consensus is people with very high risk of exposure to COVID, such as workers in frontline healthcare and quarantine facilities, should be first.

Less clear is the question of who should be next. This group could include people with work, demographic or health characteristics that put them at high risk of either exposure or serious disease.

Following a national cabinet meeting on Friday, the federal government indicated the elderly and vulnerable would be a priority group.

Here’s why prioritising older people to receive the earliest COVID vaccines is a good idea.

First, a bit of background
Vaccines work in several different ways, providing benefits to the individual and the community.

An obvious individual benefit is that vaccines can prevent infection in the person who is vaccinated. But vaccines can also reduce the amount of virus a person makes if they do end up becoming infected. This can reduce severe disease and reduce their likelihood of transmitting the virus to others.

All this leads to benefits for the community. If vaccine uptake is high enough and transmission is reduced, our collective (or herd) immunity can be used like a fire break. It blocks pathways of virus transmission and protects vulnerable people from infection, even when those people are not vaccinated.

Here’s what happens when you don’t vaccinate compared to when you do, if we were to have a vaccine that was 66 per cent effective. The figures who turn red catch COVID-19. Author provided

Severe disease due to COVID is a critical health issue, with the potential to put significant stress on healthcare systems and resources. But if vaccine supply is limited, do we:

  • directly reduce severe disease by giving the vaccine to those most at risk, such as older people
  • indirectly reduce severe disease by vaccinating the people most likely to get sick and transmit the virus, such as certain groups of younger people
  • use a mix of both strategies?

The question is, how can a limited supply of vaccine have the most impact?

Vaccines and the elderly
As we get older, our immune cells can become more difficult to activate, in response to the natural ageing process or other factors like chronic inflammation. As a result, vaccines often don’t protect older people as well as younger people.

Importantly, a phase 1 study with a BioNTech/Pfizer COVID vaccine candidate showed the size of the immune response was lower in older people, which may suggest reduced protection.

Because of this, the public might think prioritising vaccines for older people is a bad idea. Why give a vaccine to people who it won’t work as well in? But we should explore older people as a priority group for several reasons.

First, older people are bearing the brunt of severe disease from COVID. In Australia, nearly half of severe cases requiring intensive care, and more than 90 per cent of deaths, have been people over 65.

Second, a potential vaccine may not protect as well in older people, but it should protect to a degree. As an example, the flu vaccine provides 60–70 per cent protection in the general community, dropping to 30–40 per cent protection in people over 65 – but even at that rate it’s still protecting a substantial number of older people.

Third, where a potential vaccine doesn’t prevent infection, it could still reduce severe disease. For example, in one study, the flu vaccine reduced the rate of severe disease in vaccinated people by 23 per cent regardless of age group.

A modest improvement in cases or severe disease in older people could have a big impact on the overall burden of disease and death.

In particular, aged care facilities should be considered a top priority. This environment is high risk, combining people at very high risk of severe disease and high-density accommodation. Vaccinating aged care staff could prevent the virus getting in and vaccinating residents could minimise the consequences if it did.

Finally, some vaccines may work well in older people. For example, the Shingrix vaccine stunned the research community in 2015 by demonstrating over 90 per cent protection against shingles in older people — a vast improvement on the previous Zostavax vaccine which provided only 50 per cent protection.

While initial supply will be limited, we may end up with access to multiple COVID vaccines, which could allow us to prioritise potent vaccines for older people.

Big decisions take a village
In any scenario, tackling complex questions around vaccine distribution will require specialist knowledge from across many disciplines.

We need to understand how the virus spreads in a given population, how the vaccine works in different groups within that population, who might be hesitant about the vaccine, how we can deliver the vaccine to a wide variety of people and many other factors.

An elderly woman wearing a mask looks out the window. Older people are more likely to become severely unwell if they contract coronavirus. Shutterstock

Importantly, we’re still learning about this virus. It behaves differently in different communities, due to different environments, demographics, biology and behaviours. Strategies may differ in different regions and must adapt with our evolving understanding of the virus. There won’t be a one size fits all approach.

It’s also vital to keep in mind that a vaccine won’t be a silver bullet. Vaccines are not 100 per cent protective and will take time to roll out. Public health measures such as rigorous testing, hand-washing, mask-wearing and a level of social distancing will remain important for some time.

There will be challenging and contentious decisions for initial access to COVID vaccines, but ultimately vaccine supply will become less restricted. It’s important to remember we all collectively benefit by shepherding certain groups to the front of the vaccine queue.

Kylie Quinn, Vice-Chancellor's Research Fellow, School of Health and Biomedical Sciences, RMIT University

This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Do you think older people should be given priority when a vaccine is released? Will you get vaccinated, even if it’s not 100 per cent effective?

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    Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.


    To make a comment, please register or login
    16th Nov 2020
    Doctors and other health workers will most likely get the vaccine first.
    Winston Smith
    16th Nov 2020
    Yes, the article says that. Unfortunately, the headline didn't.
    16th Nov 2020
    Of course I will get vaccinated just as soon as I qualify.
    Vaccination gives us back our freedom and our family.
    16th Nov 2020
    Yes, definitely get the older people vaccinated first as they are most at risk, and often have pre existing medical conditions which lower their immune system. I'm in good health and don't plan on getting vaccinated but rather focus on staying healthy.
    16th Nov 2020
    I just love a paradox
    16th Nov 2020
    Logicaly the vaccine should be given to those people who travel, work or socialise a lot because it is those people transmitting it around. Older people are not the culprit here, they probably got the viruse of the above. I have a lot of older clients and they said they don't want the vaccine.
    16th Nov 2020
    No I don't think so we need to wait and watch for awhile to see if the boom on these vaccines are fact or fiction or have side effects that could wreck our bodies
    16th Nov 2020
    I agree with you, tobymyers, older folk have a less robust system against the younger ones. Let’s be absolutely sure that there are no potential side effects before the elderly hold out their arms.
    16th Nov 2020
    It really depends on which vaccines become available when. It may be preferable to vaccinate those most likely to spread the virus (I.E. 29-45 yo) first along with front line health care and aged care workers. On the other hand, the UQ vaccine has been, and continues to be, tested on older people with very encouraging results, so if that is available first then it makes sense to vaccinate older people first.

    How about we have a variety of plans depending on the available vaccine.
    16th Nov 2020
    The UQ vaccine won't be out first, but it might very well be the best (cheapest, most effective, most easily adapted to other viruses, most easily transported (no need for super cold conditions) and so on.

    Feds have made a good decision to back it, even though it won't be first off the rank.
    Good heavens !!! A good decision !!! We should frame it as a first.

    The other argument is that the young folk have more to offer in terms of life and potential, so it is best to back the winners, as opposed to us oldies who not that much to offer the community any more in terms of output/years. Someone has probably also done the sums on how much tax a young person will pay over the rest of their life compared to the tax we will pay for the comparably short time we have left. Which is the better $$ investment? That's the Lib way, of course. Only back economic winners, and bugger the others.
    Winston Smith
    16th Nov 2020
    The most important vaccine for me personally has been the polio vaccine. It was given to the most vulnerable first - the kids in that case. Same should apply here. The elderly in this case.
    16th Nov 2020
    Frankly, I think this is a dumb question.
    Our “front line” workers .... doctors, nurses, care givers should be first, no question.
    Then, subject to medical advice, the elderly (over 80) followed by those over 60.
    Then all those over the age of 12.
    Vaccination should be compulsory no “outs” unless medical advice is against.
    16th Nov 2020
    I think the first to be vaccineted should be our elite and for that I mean from the prime minister down. If everything goes ok then certainly the eldest should have priority.
    Winston Smith
    16th Nov 2020
    Why? There has never been a bad vaccine in Australia.
    17th Nov 2020
    There's always the first time WS and at 75 I'd be very wary to be among the first to get it.
    16th Nov 2020
    We debated this exact topic ad infinitum last week.

    Why are we rehashing it again this week with the exact same comments? Has dementia set in so badly that everyone has forgotten what happened last week?

    There is never anything new, just the same old stuff week in week out.
    Senior without family
    16th Nov 2020
    The Uq virus may not be the first available but it has shown to be more successful in tests with older people. There might be a case for waiting until that one for the actual elderly and if the Pfizer one comes first giving that to other frontline workers. Yes I will get vaccinated but would prefer the uq one since I am elderly and have a compromised immune system and other health problems. Without a vaccine if I get covid I would be unlikely to survive in reality.
    16th Nov 2020
    Why is this question being asked? Because certain people in our society think we are expendable, and quess who they might be? The LNP. Reminds me of that 1970's Charleston Heston movie "soylent green".
    16th Nov 2020
    If I had to make a decsion between me as an elderly person and my son I would give it to him.
    He is not on the front line but is classified as an essential worker. I have had my life and he has his still to live. If I was lucky enough to have some left over when all of the frontline workers and the essential worker I would gratefully take it.
    The younge have already stepped up to trial the vaccine.
    There have been less flu deaths reported in Aged care than last year. A friend who works in age care said that every year so many older residents do not make it through the winter due to flu so how can you really judge the figures.
    Peter H
    16th Nov 2020
    Why bother vaccinating us older people. We are treated as a burden on society despite what contribution we have made in taxes.
    Easy Rider
    17th Nov 2020
    I don't care who gets it first as long as they volunteer to have it. It should NEVER be forced upon anyone. There is nothing more personal or intrusive than to have a concoction of foreign substances forcibly injected into an individual's body. It is quite possible that there will be threats of withholding the aged pension for those who refuse vaccination....and all the clapping seals will applaud it!
    17th Nov 2020
    I'm surprised how many anti-vaxxers are commenting on here.
    vaccines have saved the lives of millions of people and have been in use since the 18th century. Smallpox has been eliminated and soon polio will. i suppose a topic such as this will draw comments form those opposed to vaccination rather than those in favour of it. Unless the Covid-19 virus suddenly becomes less virulent and infectious, we will need a vaccine if we wish to get back to any kind of normality in our lives.
    17th Nov 2020
    Many anti-vaxers are not really anti-vaxers, Mimi. I was vaccinated for everything when I was growing up and I made sure the children’s vaccinations were up to date. I’ve always been a pro-vaxer. But these days I have less trust in the manufacturing companies especially as they all seem to have a clause in their contracts that they are not liable or responsible for any detrimental effects their vaccines may cause.
    17th Nov 2020
    there have always been side-effects with medications and vaccinations however like many things we were more aware of the disease, yet less aware of actual and potential issues than today. That does not mean to say however that greedy big pharma and lazy GPs is beyond placing profit ahead of patient interest.
    17th Nov 2020
    Just as elderly folks line up to get free flu shots every year, they should be towards the front of the line along with health workers and low immunity groups.
    18th Nov 2020
    Do people realise that the trials are done on young healthy people and very few older people are included. These older people have to be healthy with no heart or other diseases. Why would anyone have a vaccine not tested on their age group?
    18th Nov 2020
    Thanks Goldy. I blacked out using a new nasel spray and a seizure after taking a decongestant. If i did the trial I would probably be very sick. No vaccine for me im to sensitive to medications. Im not a young person.
    18th Nov 2020
    Pfizer's BNT162b2 phase 2 trial included 45 in the 65-85 age group. This was the candidate selected for the Phase 3 trial. There is no reason to believe this same age group was excluded from the phase 3 sample.
    18th Nov 2020
    Excuse me but if you listen to the last Health Report with Norman Swan - he states these vaccines have not been tested on older people - go figure.. Also the side effects are very worrying in a high number of young healthy people:
    Johnson & Johnson temporarily paused Phase 3 clinical trials of its COVID-19 vaccine on Monday after one participant experienced what the company termed “an unexplained illness.” So far no explanation.

    Moderna vaccine: “Three of the 15 human guinea pigs in the high dose cohort (250 mcg) suffered a ‘serious adverse event’ within 43 days of receiving Moderna’s jab. Moderna … acknowledged that three volunteers developed Grade 3 systemic events defined by the FDA as ‘Preventing daily activity and requiring medical intervention.’

    Moderna allowed only exceptionally healthy volunteers to participate in the study. A vaccine with those reaction rates could cause grave injuries in 1.5 billion humans if administered to ‘every person on earth.’

    AstraZeneca -Oxford vaccine:
    2 healthy people experienced significant neurological disease.
    A clear majority of participants experienced side effects.

    1 Voluntunteer died in Brazil - the cause of death not disclosed as yet.

    “Fatigue and headache were the most commonly reported systemic reactions. Fatigue was reported in the ChAdOx1 nCoV-19 group by 340 (70%) participants without paracetamol and 40 (71%) with paracetamol …

    Headaches were reported in the ChAdOx1 nCoV-19 group by 331 (68%) participants without paracetamol and 34 (61%) with paracetamol … Other systemic adverse reactions were common in the ChAdOx1 nCoV-19 group:

    muscle ache (294 [60%] participants without paracetamol and 27 [48%] with paracetamol)
    malaise (296 [61%] and 27 [48%])
    chills (272 [56%] and 15 [27%])
    feeling feverish (250 [51%] and 20 [36%]). In the of ChAdOx1 nCoV-19 group, 87 (18%) participants without paracetamol and nine (16%) participants with paracetamol reported a temperature of at least 38°C, and eight (2%) patients without paracetamol had a temperature of at least 39°C”
    18th Nov 2020
    Yes, so the answer is to vaccinate younger people to push down the virus which in turn reduces the incidences in older people.
    18th Nov 2020
    The article mentions a Pfizer phase one candidate was less effective in older cohort. There were 45 in the 65-85 age groups for each of the phase 2 candidates, including the one selected for phase 3 trials. Trial data makes it clear that the 45,000 sample size is to include over 55s. There is no reason to assume this is not the case.

    19th Nov 2020
    With all those possible side effects and having tested positive to Covid-19 to me it would be better just to treat the few that get sick rather than expose people to all those side effects. I have had no symptoms at all myself.
    21st Nov 2020
    Let us hope that there will be sufficient supplies for all that wish to have the vaccination. If not, give it to those that are vulnerable first, be it age, youth, front-line workers , pre-existing health situation etc. Let's hope that those anti-vaxers are not in a social situation that they could spread it throughout should they get the virus or are asymptomatic!!!
    21st Nov 2020
    Thanks Koro, guess I will have to stay away from people who have the vaccine, as i will not be having the vaccine, i am too sensitive to vaccine's and medication.

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