Abstract
OBJECTIVE: To characterise the optimal targeting of age and risk groups for COVID-19 vaccines. DESIGN: Motivated by policies in Japan and elsewhere, we consider rollouts that target a mix of age and risk groups when distributing the vaccines. We identify the optimal group mix for three policy objectives: reducing deaths, reducing cases and reducing severe cases. SETTING: Japan, a country where the rollout occurred over multiple stages targeting a mix of age and risk groups in each stage. PRIMARY OUTCOMES: We use official statistics on COVID-19 deaths to quantify the virus transmission patterns in Japan. We then search over all possible group mix across rollout stages to identify the optimal strategies under different policy objectives and virus and vaccination conditions. RESULTS: Low-risk young adults can be targeted together with the high-risk population and the elderly to optimally reduce deaths, cases and severe cases under high virus transmissibility. Compared with targeting the elderly or the high-risk population only, applying optimal group mix can further reduce deaths and severe cases by over 60%. High-efficacy vaccines can mitigate the health loss under suboptimal targeting in the rollout. CONCLUSIONS: Mixing age and risk groups outperforms targeting individual groups separately, and optimising the group mix can substantially increase the health benefits of vaccines. Additional policy measures boosting vaccine efficacy are necessary under outbreaks of transmissible variants.