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WHO SAGE Roadmap For Prioritizing Uses Of COVID-19 Vaccines In The Context Of Limited Supply - An approach to inform planning and subsequent recommendations based on epidemiological setting and vaccine supply scenarios (Version 16 July 2021)

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On 29 June, the WHO Strategic Advisory Group of Experts on Immunisation (SAGE) met with the objective of discussing needed updates to the COVID-19 vaccine prioritization roadmap, first published in November 2020. The notice of that meeting, including an agenda can be found here. The updated SAGE roadmap was published on 16 July and is available here.

The updated SAGE Roadmap offers recommendations on how vaccines should be prioritized in countries with limited supply for maximum public health impact, taking into account the most recent evidence on COVID-19 vaccines and on the ongoing supply constraint issues faced by the COVAX Facility. This update reflects data that has become available from clinical vaccine studies, as well as lessons learned from the early implementation of programmes.

The recommendations include expanding the groups included in Stage II of the prioritization roadmap to include pregnant women and children with underlying health conditions, and updates regarding clinical trials for lactating women.

Key updates

On pregnancy:

· Evidence suggests that pregnant people have a higher risk of severe outcomes from SARS-COV2 infection. COVID-19 infection in pregnancy has also been linked to an increased risk of preterm birth and newborn babies requiring intensive care.

· In line with other health states that put individuals at higher risk, pregnant women are now placed in Stage II of the epidemiological scenarios of the SAGE prioritization roadmap, in particular pregnant women of higher age, and those with comorbidities.

On breastfeeding women:

· There is, as yet, little evidence to evaluate whether breastfeeding women are at risk of severe COVID-19

· Some short-term studies have suggested there is no risk to the infants from immunisation of lactating mothers, and early limited data suggests that protection from the vaccine may be conferred from mother to child.

· WHO does not recommend discontinuing breastfeeding because of vaccination. Breastfeeding is one of the most effective ways to ensure child health and survival. Those who are breastfeeding have a right to discontinue breastfeeding at any time they wish, but there is no need to discontinue it because of vaccination.

On children:

· As of 16 July, SAGE has only reviewed the evidence for the Pfizer COVID-19 vaccine in children above the age of 12.

· Current evidence suggests that children with underlying conditions are at increased risk of severe illness from SARS COV2 infections, although children in general are less likely to suffer from severe disease and death following COVID-19 infection/disease.

· Children and adolescents with underlying health conditions should be included in stage II of roll-out of vaccines where community transmission is high, or where there is a risk of clusters of cases forming. In these cases, adults in the same prioritization group should be vaccinated before children with underlying health conditions.