Strategies to Mitigate COVID-19 Resurgence Assuming Immunity Waning: A Study for Karnataka, India

COVID-19 vaccination is being rolled out among the general population in India. Spatial heterogeneities exist in seroprevalence and active infections across India. Using a spatially explicit age-stratified model of Karnataka at the district level, we study three spatial vaccination allocation strategies under different vaccination capacities and a variety of non-pharmaceutical intervention (NPI) scenarios. The models are initialised using on-the-ground datasets that capture reported cases, seroprevalence estimates, seroreversion and vaccine rollout plans. The three vaccination strategies we consider are allocation in proportion to the district populations, allocation in inverse proportion to the seroprevalence estimates, and allocation in proportion to the case-incidence rates during a reference period. The results suggest that the effectiveness of these strategies (in terms of cumulative cases at the end of a four-month horizon) are within 2% of each other, with allocation in proportion to population doing marginally better at the state level. The results suggest that the allocation schemes are robust and thus the focus should be on the easy to implement scheme based on population. Our immunity waning model predicts the possibility of a subsequent resurgence even under relatively strong NPIs. Finally, given a per-day vaccination capacity, our results suggest the level of NPIs needed for the healthcare infrastructure to handle a surge.