Ranking the relative importance of COVID-19 immunisation strategies: a survey of expert stakeholders in Canada

BackgroundIn the face of anticipated limited COVID-19 vaccine supply necessitating the vaccination of certain groups earlier than others, the assessment of values and preferences of stakeholders is an important component of an ethically sound vaccine prioritisation framework. ObjectiveTo establish a preliminary expert stakeholder perspective on the relative importance of pandemic immunisation strategies for different COVID-19 pandemic scenarios at the time of initial COVID-19 vaccine availability. MethodsA survey was conducted by an email process from July 22 to August 14, 2020. Stakeholders included clinical and public health expert groups, provincial and territorial committees and national Indigenous groups, patient and community advocacy representatives and experts, health professional associations, and federal government departments in Canada. Survey results were analysed using descriptive statistics. ResultsOf 156 stakeholders contacted, 74 surveys were completed for a participation rate of 47.4%. During an anticipated period of initial vaccine scarcity for all pandemic scenarios, stakeholders generally considered the most important immunisation strategy to be protecting those who are most vulnerable to severe illness and death from COVID-19. This was followed in importance by the strategies to protect healthcare capacity, and to minimise transmission of COVID-19. In this supply constrained context, an immunisation strategy to protect critical infrastructure was considered the least important. ConclusionThe findings of this study provide a timely, preliminary Canadian expert perspective on priority COVID-19 pandemic immunisation strategies to guide early public health planning for an eventual COVID-19 immunisation program. These results fill a gap in the literature and could help advisory groups around the world in their assessment of values and preferences for ethical guidelines for COVID-19 vaccine allocation.