Table 2 Important factors in assessing national needs for COVID-19 vaccines, Delphi round one results

Disease burden

Proportion of population clinically vulnerable to severe disease (including elderly, co-morbidities, obesity)

Health system capacity for COVID patients (including ICU beds)

Overall health system capacity (including both COVID and non-COVID)

Burden of other infectious diseases of epidemic potential (e.g. Measles, Ebola, HIV)

COVID deaths per million

Excess mortality per million

Disease control

Proportion of high-risk groups not vaccinated already (elderly, clinically vulnerable, HCWs^a)

Proportion of population not already vaccinated with at least 1 dose against nationally dominant variant

Trend in COVID-19 case numbers per 100,000 (accounting for case recording variability/positivity)

Level of disease transmission, e.g. R0 (accounting for case recording variability/positivity)

Testing and contact tracing capacity (i.e. ability to control outbreaks in the absence of vaccines)

Estimated level of compliance with non-pharmaceutical interventions and presence of legal structures to enforce (e.g. distancing, facemasks)

Seropositivity estimates in unvaccinated (i.e. level of naturally acquired immunity)

Prevalence of more lethal or transmissible variants (VOC^b)

Vaccine efficacy against nationally dominant variant

Geographic

Proximity to countries in crisis/with variant of concern

International connectedness/travel (e.g. being a regional or international hub)

Climate/seasonality

Social & Demographic

Population density

Urbanicity

Number of essential workers (frontline services) per population

Number of health and social care workers per population

Number of people living in institutional or overcrowded settings e.g. care homes, prisons, migrant worker camps, slums etc. per population

Numbers of individuals with refugee or displaced status, or in need of humanitarian assistance per population

Social inequality (e.g. GINI index)

Human development index (favouring less developed where reaching herd immunity may take longer)

Economic

Proportion of population on daily wage earnings (i.e. informal sector)

Estimated economic impact of business closures/lockdowns/NPIs

Proportion of population living below poverty line

Unemployment (% labour workforce)

GDP^c per capita (prioritising poorer countries)

Capacity to purchase vaccines in competitive global market

Capacity to produce vaccines in country

Readiness and use

Capacity to distribute vaccines in country (must be used to trigger support rather than exclusion)

Communication plans and mechanisms for community monitoring (including inequity in uptake across population groups)

Existence of equitable national vaccine deployment and prioritisation plan

Population acceptance of vaccines/hesitancy