Is Equitable Priority Vaccination of Vulnerable People Feasible in a Real-World Context? The Case of Belgium

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Abstract Background: Belgium is the only country to have implemented a comprehensive, proactive, and equitable strategy to prioritize vaccination at population level during the COVID-19 pandemic. This prioritization targeted individuals with pre-existing health conditions, who were at increased risk of severe COVID-19. They were identified through both centralized (Health Insurance Funds database) and decentralized (Electronic Health Records from Family Physicians) data as high-risk. We aimed to evaluate whether prioritized groups were vaccinated sooner, and which socio-demographic and -economic characteristics were related to the speed of vaccine uptake.Methods: We calculated the time to vaccination between the start of the prioritization (1st April 2021) and receiving a first COVID-19 vaccine dose, using this interval as a proxy for evaluating the strategy's early impact. A multivariate regression model, incorporating priority status, age, sex, region of residence, income, and migration background, described the natural logarithm of this time gap. The data was obtained through the LINK-VACC project.Results: The sample included 4,517,802 individuals vaccinated between 1st April and 31st December 2021, of which 26.3% were prioritized. The results show a 34.7 days earlier vaccination for prioritized individuals versus non-prioritized ones. The time difference between the prioritized and non-prioritized groups was larger in younger age groups compared to older age groups (27.7 days versus 19.3 days). Based on the multivariate model estimates, being prioritized (β_priority= -0.3, 95%CI (-0.38;-0.36)), older age (β_(55-64)= -0.56, 95%CI(-0.57;-0.55)), residency in Brussels or Wallonia (β_Brussels= -0.18, 95%CI(-0.20;-0.16);β_Wallonia= -0.18, 95%CI(-0.19;-0.17)), having a high income (β_(high income)= -0.11, 95%CI(-0.12;-0.10)), being a Belgian national (β_belgian= reference) and being female (β_female= reference) are associated with a shorter time to vaccination.Conclusion: Developing and implementing a prioritization vaccination strategy accelerated vaccination for the high-risk population with health conditions, demonstrating its feasibility in promoting equitable access to COVID-19 vaccines.

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