Spatial Allocation of Scarce COVID-19 Vaccines^*†‡

The COVID-19 Vaccines Global Access (COVAX) is an initiative led by the World Health Organization (WHO) and other partners that aims for an equitable access of COVID-19 vaccines. Despite a potential heterogeneous disease burden across space, countries receiving allotments of vaccines via COVAX may want to follow WHO’s allocation rule and distribute vaccines to their jurisdictions based on the jurisdictions’ relative population size. Utilizing economic–epidemiological modeling, we benchmark the performance of thisad hocallocation rule by comparing it to the rule that minimizes the economic damages and expenditures over time, including a penalty cost representing the social costs of deviating from thead hocallocation. Under different levels of vaccine scarcity and different demographic characteristics, we consider scenarios where length of immunity and compliance to travel restrictions vary, and consider the robustness of the rules when assumptions regarding these factors are incorrect. The benefits from deviating are especially high when immunity is permanent, when there is compliance to travel restrictions, when the supply of vaccine is low, and when there is heterogeneity in demographic characteristics. Interestingly, a lack of compliance to travel restrictions pushes the optimal allocations of vaccine towards thead hocand improves the relative robustness of thead hocrule, as the mixing of the populations reduces the spatial heterogeneity in disease burden.