COVID-19 Vaccination Strategies in Settings with Limited Rollout Capacity: A Mathematical Modelling Case Study in Sierra Leone

Background: COVID-19 vaccine coverage in low- and middle-income countries continues to be challenging. As supplies increase, coverage is increasingly becoming determined by rollout capacity.Methods: We developed a deterministic compartmental model of COVID-19 transmission to explore how age-, risk-, and dose-specific vaccine prioritisation strategies can minimise severe outcomes of COVID-19 in Sierra Leone.Findings: Prioritising booster doses to older adults and adults with comorbidities could reduce the incidence of severe disease by 21% and deaths by 32% compared to the use of these doses as primary doses for all adults. Providing a booster dose to pregnant women who present to antenatal care could prevent 39% of neonatal deaths associated with COVID-19 infection during pregnancy. The vaccination of children is not justified unless there is sufficient supply to not affect doses delivered to adults.Interpretation: Our paper supports current WHO SAGE vaccine prioritisation guidelines (released January 2022). Individuals who are at the highest risk of developing severe outcomes should be prioritised, and opportunistic vaccination strategies considered in settings with limited rollout capacity.Funding Information: GMB was supported by the Australian Government Research Training Program during this study.Declaration of Interests: The authors declare no competing interests for this work.