Prioritizing COVID-19 vaccination efforts and dose allocation within Madagascar.

BACKGROUND: While mass COVID-19 vaccination programs are underway in high-income countries, limited availability of doses has resulted in few vaccines administered in low and middle income countries (LMICs). The COVID-19 Vaccines Global Access (COVAX) is a WHO-led initiative to promote vaccine access equity to LMICs and is providing many of the doses available in these settings. However, initial doses are limited and countries, such as Madagascar, need to develop prioritization schemes to maximize the benefits of vaccination with very limited supplies. There is some consensus that dose deployment should initially target health care workers, and those who are more vulnerable including older individuals. However, questions of geographic deployment remain, in particular associated with limits around vaccine access and delivery capacity in underserved communities, for example in rural areas that may also include substantial proportions of the population. METHODS: To address these questions, we developed a mathematical model of SARS-CoV-2 transmission dynamics and simulated various vaccination allocation strategies for Madagascar. Simulated strategies were based on a number of possible geographical prioritization schemes, testing sensitivity to initial susceptibility in the population, and evaluating the potential of tests for previous infection. RESULTS: Using cumulative deaths due to COVID-19 as the main outcome of interest, our results indicate that distributing the number of vaccine doses according to the number of elderly living in the region or according to the population size results in a greater reduction of mortality compared to distributing doses based on the reported number of cases and deaths. The benefits of vaccination strategies are diminished if the burden (and thus accumulated immunity) has been greatest in the most populous regions, but the overall strategy ranking remains comparable. If rapid tests for prior immunity may be swiftly and effectively delivered, there is potential for considerable gain in mortality averted, but considering delivery limitations modulates this. CONCLUSION: At a subnational scale, our results support the strategy adopted by the COVAX initiative at a global scale.

Seed dormancy and delayed flowering in monocarpic plants: selective interactions in a stochastic environment.

We explore the effects of temporal variation in multiple demographic rates on the joint evolution of delayed reproduction and seed dormancy using integral projection models (IPMs). To do this, we extend the standard IPM to include a discrete state variable representing the number of seeds in the seed bank, density-dependent recruitment, and temporal variation in demography. Parameter estimates for Carlina vulgaris and Carduus nutans are obtained from long-term studies. Carlina is relatively long lived and has a short-lived seed bank, whereas most Carduus plants flower in their first year and the seed bank is long lived. Using the evolutionarily stable strategy (ESS) approach, we predict the observed flowering and germination strategies. There is excellent agreement between the predictions and the field observations. The effects of temporal variation on the joint ESS are partitioned into components arising from nonlinear averaging (systematic changes in the mean resulting from the interaction between variability and nonlinearity) and nonequilibrium dynamics (fluctuations in fitness caused by temporal variation). This shows that temporal variation can have substantial effects on the observed flowering and germination strategies and that covariance between demographic processes is important. We extend the models to include spatial population structure and assess the robustness of the results from the nonspatial models.