Prioritising older individuals for COVID-19 booster vaccination leads to optimal public health outcomes in a range of socio-economic settings.

The rapid development of vaccines against SARS-CoV-2 altered the course of the COVID-19 pandemic. In most countries, vaccinations were initially targeted at high-risk populations, including older individuals and healthcare workers. Now, despite substantial infection- and vaccine-induced immunity in host populations worldwide, waning immunity and the emergence of novel variants continue to cause significant waves of infection and disease. Policy makers must determine how to deploy booster vaccinations, particularly when constraints in vaccine supply, delivery and cost mean that booster vaccines cannot be administered to everyone. A key question is therefore whether older individuals should again be prioritised for vaccination, or whether alternative strategies (e.g. offering booster vaccines to the individuals who have most contacts with others and therefore drive infection) can instead offer indirect protection to older individuals. Here, we use mathematical modelling to address this question, considering SARS-CoV-2 transmission in a range of countries with different socio-economic backgrounds. We show that the population structures of different countries can have a pronounced effect on the impact of booster vaccination, even when identical booster vaccination targeting strategies are adopted. However, under the assumed transmission model, prioritising older individuals for booster vaccination consistently leads to the most favourable public health outcomes in every setting considered. This remains true for a range of assumptions about booster vaccine supply and timing, and for different assumed policy objectives of booster vaccination.

Learning transmission dynamics modelling of COVID-19 using comomodels.

The COVID-19 epidemic continues to rage in many parts of the world. In the UK alone, an array of mathematical models have played a prominent role in guiding policymaking. Whilst considerable pedagogical material exists for understanding the basics of transmission dynamics modelling, there is a substantial gap between the relatively simple models used for exposition of the theory and those used in practice to model the transmission dynamics of COVID-19. Understanding these models requires considerable prerequisite knowledge and presents challenges to those new to the field of epidemiological modelling. In this paper, we introduce an open-source R package, comomodels, which can be used to understand the complexities of modelling the transmission dynamics of COVID-19 through a series of differential equation models. Alongside the base package, we describe a host of learning resources, including detailed tutorials and an interactive web-based interface allowing dynamic investigation of the model properties. We then use comomodels to illustrate three key lessons in the transmission of COVID-19 within R Markdown vignettes.