The Implementation of Mass-Vaccination against SARS-CoV-2: A Systematic Review of Existing Strategies and Guidelines
2. Materials and Methods
2.1. Search Strategy—Research Articles
2.2. Search Strategy: Non-Peer Reviewed Literature
2.3. Data extraction and Analysis
2.4. Ethical Issues
3.1. National Policy Documents
3.2. Vaccine Deployment
3.3. Vaccination of Priority Groups
3.4. Infrastructure and Staffing for Vaccination
3.5. Peer-Reviewed Research of Vaccination Outcomes
|Setting/Country||Australia||USA||Czech Republic||Qatar||Singapore||Monaco||Canada||Switzerland||EU||UK||South Africa||Lebanon||Cyprus||New Zealand||Ireland|
|Date of most recent update||17 February 2021||29 October 2020||10 February 2021||NR||26 February 2021||23 February 2021||25 February 2021||26 February 2021||1 February 2021||11 January 2021||NR||28 January 2021||2020||22 December 202||24 February 2021|
|Vaccination mandatory for target populations?||No||NR||NR||NR||No||No||No||No||No||No||NR||NR||No|
|Was an increased delay between the two doses recommended (compared to the frequency in published trials)||NR||NR||NR||NR||Priority 1||NR||NR||In 2 countries||Yes||Priority 1||NR||NR||NR|
|EQUITABLE ACCESS||Priority 1||Priority 2|
|Priority criteria for vaccination||NR||Priority 1|
|Frontline HCW||Priority 1||Priority 1||Priority 1||Priority 1||Priority 1||Priority 2||Priority 1||Priority 2||Priority 2||Priority 1||Priority 1||Priority 2|
|Chronic comorbidities||Priority 2||Priority 2||Priority 2||Priority 1||Priority 1||Priority 1||Priority 4||Priority 4|
|Elderly in aged care||Priority 1||Priority 2||Priority 1||Priority 1||Priority 1||Priority 1||Priority 1||Priority 1||Priority 1|
|Other elderly||Priority 2||Priority 2||Priority 1||Priority 1||Priority 1||Priority 1||Priority 2||Priority 2||Priority 1||Priority 3|
|Institutionalised||Priority 3||Priority 2||Priority 4||Priority 2||Priority 5|
|Indigenous population||Priority 2||Priority 3||Priority 1|
|Other HCW||Priority 2||Priority 2||NR||NR||Priority 1||NR||Priority 2||NR|
|Essential public services||Priority 3||Priority 2||NR||NR||NR||Yes|
|Expected date when whole adult population vaccinated||NR||NR||NR||NR||Sep 2021||NR||NR||NR||NR||NR||Mid 2022||NR||NR|
|Will extra doses be donated to COVAX||Yes||NR||NR||NR||Yes||NR||Yes||NR||Yes||NR||NR||NR|
|Location of vaccination||NR||NR||NR||NR|
|Large public venues||Yes||Yes||Drive through||Care home||Yes||Yes||Yes||Yes||Yes|
|Clinics and pharmacies|
|Yes||Yes||NR||Self-reported to clinic, hotline, or email||Yes||Yes||NR||Yes||NR||Yes|
|Vaccination record (electronic/paper)||NR||NR||NR||NR||NR||Paper||Electronic||Electronic||Electronic||Electronic||NR|
|Adverse-effect reporting (automated electronic, electronic self-report, GP self-report)||Active surveillance via electronic prompts||NR||NR||NR||Self-reported to local doctor||NR||NR||NR||5 countries with self-reported electronic system||Review of electronic health records||NR||Self-reported electronic system||NR||9 extra freezer procured||NR|
|Cold chain infrastructure||NR||Extra freezer procured||NR||NR||NR||NR||NR||NR||Extra freezer procured||NR||NR||1 freezer procured||Freezer available||NR|
|Increased labour requirements||NR||NR||NR||NR||Yes||NR|
|Non-medical staff employed for vaccination||Yes||Yes||Yes||Yes||Yes||Yes|
|Training provided to staff||Yes||Yes||NR||NR||Yes||Yes||NR||Yes||NR|
|Are the following employed?||NR||NR||NR||NR||NR||NR|
|Other||Qatar||Monaco||Celebrities||South Africa||New Zealand|
|Strategies to reduce misinformation||NR||NR||NR||NR||NR||23 February 2021||NR||NR||Monitor media, online fact checker||NR||NR||Rumour tracking team||NR||22 December 202||NR|
|Country/Reference||Peer Reviewed (Yes/No)||Number Vaccinated in Study||Age Groups Immunised||Female (%)||Vaccines Used (% *)||Outcomes|
|Studies reporting demographic details|
Gharpure et al. 
|Yes||713,909 (LTCF residents)|
|NR||NR||NR||Estimated 77.8% residents and 37.5% staff in 11,460 care facilities, vaccinated by Jan 17 (at least one dose)|
Painter et al. 
|Studies reporting adverse events|
Pagotta et al. 
|No||683 (HCW)||99.3% 18–60|
|68||Gamaleya||Adverse effects reported by 71.3% in a survey. Most common—injection site pain, myalgia, fever|
Jayadevan et al. 
|Adverse effects reported by 65.9% in a survey, highest in those 20–39 years of age and females. |
Most common adverse effects—lethargy, myalgia, fever
|Yes||4,041,396||NR||NR||Mod||Anaphylaxis reported in 0.0002% (n = 10), serious adverse effects in 0.03% (n = 1266)|
|Yes||1,893,360||NR||NR||Pf/B||Anaphylaxis reported in 0.001% (n = 21), serious adverse effects in 0.2% (n = 4393)|
Gee et al. 
|Adverse effects reported in 0.05% (n = 6994) through a passive national surveillance system|
McMurray et al. 
|Review of electronic medical records found a 2.1 to 1500 times reduced frequency of adverse events reported when events were obtained from self-reported health interactions compared to active solicitation in trials or in post-marketing surveillance|
|Studies reporting vaccine acceptance|
Barry et al. 
|No||352 (HCW)||91.9% 20–50|
|57||Pf/B||Factors associated with not enrolling for vaccine: female, younger age, use of social media, foreign national.|
Percentage not yet registered for vaccine: 66.7% (n = 706)
Martin et al. 
|No||12,278 (HCW)||18.7% <30|
|Factors associated with lower vaccine uptake: ethnic minority, younger age, female, lower socio-economic status|
|No||66,994||NR||NR||NR||Factors associated with vaccine uptake—pre-pandemic income, education.|
Least likely to take up vaccination—Black Hispanics
Pamplona, Sullivan, Kotanko 
|Yes||115 (HCW)||NR||NR||NR||Factors associated with not being vaccinated in a dialysis ward (26.8%, n = 42)—past COVID-19, pregnancy, absence. 3.8% (n = 6) declined vaccine|
Schradering et al. 
|Yes||1136 (HCW)||98.6% 22–64|
|59||NR||14% (n = 195) HCWs refused vaccination—usually for concern about adverse effects. |
Ethnic group most likely to decline vaccine: with non-Hispanic black HCWs
|Studies reporting efficacy (excluding Phase 2 and 3 trials of vaccine efficacy)|
Abu Jabal et al. 
|63||Pf/B||Immunogenicity post vaccination similar by ethnicity and sex, but decrease with age. Increased immunogenicity in previous COVID-19 cases|
Amit et al. 
|Yes||4081||NR||NR||Pf/B||In vaccinated HCW, 0.54% (n = 22) developed COVID-19 within 10 days of vaccination|
Amit et al. 
|Yes||NR||NR||NR||NR||30% and 75% reduction in SARS-CoV-2 cases in vaccinated HCW vs. unvaccinated HCW 14 and 28 days, respectively after vaccination|
|No||NR||NR||NR||Pf/B||72% reduction in cases and 83% reduction in hospitalisation by modelling|
Chodick et al. 
|No||503,875||Mean 59.7||52||Pf/B||Cases of COVID-19 infection 24 days post vaccination: 0.84% (n = 3098)|
51% vaccine effectiveness calculated after 1st dose
Dagan et al. 
|50||Pf/B||92% reduction in COVID-19 cases, 87% reduction in hospitalisation, 72% reduction in deaths: at 7 days after second dose|
De Leon et al. 
|No||NR||NR||NR||>50% estimated vaccine effectiveness by modelling|
Levine et al. 
|No||1755 COVID-19 cases after vaccination||NR||NR||NR||Four-fold reduction in SARS-CoV-2 viral load for people developing infections 12–28 days after first dose|
Petter et al. 
|No||NR||NR||NR||NR||1.6 to 20x reduction in overall SARS-CoV-2 viral load by vaccinating the community|
Rossman et al. 
|No||NR||NR||NR||Pf/B||49% drop in cases, 36% drop in hospitalisations: 1.5 months after vaccine initiation|
Vasileious et al. 
|61||Pf/B||Estimated efficacy of single dose 85% (Pfizer) and 94% (AstraZeneca) at 28–34 days post vaccination|
81% reduction in hospitalisation in those over 80
Hall et al. 
|Vaccine effectiveness at 21 days: 72% after 1 dose, 86% after 2 doses|
67% receiving vaccine had previous COVID-19
Bradley, Grundberg, Selvarangan 
|No||188 (HCW)||NR||NR||NR||HCW with previous documented SARS-COV-2 infection have higher IgG titres after COVID-19 vaccination|
- Vaccinate health care workers, elderly, and those with chronic comorbidities as a priority.
- Utilise mass vaccination hubs such as sporting venues, for maximal scale and efficiency.
- Consider novel delivery techniques such as drive-through clinics for the second dose, where this is feasible and culturally acceptable.
- Consider use of automated electronic surveys for monitoring side-effects among all recipients.
- Engage the community to increase vaccination awareness and acceptance including by
- Including and training volunteers in the vaccination effort.
- Using social media and media campaigns to raise awareness.
- Having a means to monitor mis-information.
- Utilising high profile "champions", such as political leaders and social celebrities. Support COVAX and global commitments to deliver vaccines to marginalised and vulnerable populations, because everyone deserves to be protected and the global population cannot be safe until we are all vaccinated.
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Hasan, T.; Beardsley, J.; Marais, B.J.; Nguyen, T.A.; Fox, G.J. The Implementation of Mass-Vaccination against SARS-CoV-2: A Systematic Review of Existing Strategies and Guidelines. Vaccines 2021, 9, 326. https://doi.org/10.3390/vaccines9040326
Hasan T, Beardsley J, Marais BJ, Nguyen TA, Fox GJ. The Implementation of Mass-Vaccination against SARS-CoV-2: A Systematic Review of Existing Strategies and Guidelines. Vaccines. 2021; 9(4):326. https://doi.org/10.3390/vaccines9040326Chicago/Turabian Style
Hasan, Tasnim, Justin Beardsley, Ben J. Marais, Thu Anh Nguyen, and Greg J. Fox. 2021. "The Implementation of Mass-Vaccination against SARS-CoV-2: A Systematic Review of Existing Strategies and Guidelines" Vaccines 9, no. 4: 326. https://doi.org/10.3390/vaccines9040326