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?:abstract
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Background: We aimed at minimizing loss of lives in the Covid-19 pandemic in the USA by identifying optimal vaccination strategies during a 100-day period. While lethality is highest in the elderly, transmission and case numbers are highest in the young. Due to limited vaccine availability, a strategy of first vaccinating the elderly is widely used. Vaccines elicit enhanced immune responses in younger persons compared to the elderly, but even in the latter, mRNA vaccines are effective, implying that in the young, lower vaccine doses might suffice for protection, thereby increasing the number of persons that can be vaccinated. Methods: Using published immunogenicity data of the Moderna mRNA-1273 vaccine, we examined the value of tailored-dose vaccination strategies, using a modeling approach that incorporates age-related vaccine immunogenicity, social contact patterns, population structure, Covid-19 case and death rates in the U.S. in late January 2021. Reduced dose vaccination in the young multiplies the number of individuals vaccinated early. Results: Age-tailored dosing strategies led to faster case reduction and thereby shortened the pandemic, reducing the delay to reaching <100\'000/day from 64 to 30 days and avoiding 25\'000 deaths within 100 days in the USA. While regular vaccination of the elderly can continue, the main protection of the elderly resulted from stopping the pandemic by vaccinating a large number of young persons by age-adapted dosing. Conclusion: Rapid reduction of Covid-19 case and death rate in the U.S. can be best achieved by using highly effective vaccines in an age-tailored dosing regimen. Protecting the vulnerable is most effectively achieved by dose tailored vaccination of all population segments, while an \'elderly first\' approach costs more lives, even in the elderly.
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