News that several COVID-19 vaccine candidates seem to be at least 90% efficacious were received with much enthusiasm and an unquestionable sense of relief. But other challenges lie ahead, including coping with a demand that will far exceed their initial supply. As a result, nations and expert organisations must select which groups will first be immunised. Age-tiered approaches that also prioritise health and social care workers will reduce mortality and alleviate the pressure on health systems, but other vulnerable groups must not be forgotten. Current evidence suggests that adults of any age with certain underlying health conditions (including diabetes) are at increased risk for severe COVID-19. According to a revised ranking issued in November, 2020, in the UK, all adults deemed clinically extremely vulnerable (eg, those with specific cancers, severe respiratory conditions, and recipients of solid organ transplants) were placed in the same priority group as people aged 70–74 years. All high-risk adults younger than 65 years (including those with type 1 diabetes, type 2 diabetes, and severe obesity [BMI ≥40 kg/m2]) were placed in the priority queue ahead of people aged 60–64 years.
Vaccination priority lists are not universally agreed and may or may not be subject to public consultation in different jurisdictions. Nations will face different challenges in vaccine allocation depending on various economic, political, social, and epidemiological factors. And vaccine planning will change with enhanced knowledge of both virus and vaccines. For example, data on seroconversion and seroprotection for patients with comorbidities are currently scarce since in many phase 1/2 trials those groups were excluded due to safety considerations. For the vaccine candidates with efficacy data announced so far, no data for patients with chronic health conditions have been disclosed at the time of writing.
Although there are excellent reasons to be optimistic about the new COVID-19 vaccine candidates, it is essential that comorbidity data be disclosed as soon as available and used to inform vaccine planning. We owe those most clinically vulnerable in our communities nothing less.
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