Modelling the impact of population mobility, post-infection immunity and vaccination on SARS-CoV-2 transmission in the Dominican Republic

Abstract

COVID-19 epidemic dynamics are driven by a complex interplay of factors including population behaviour, government interventions, new variants, vaccination campaigns and immunity from prior infections. We aimed to quantify the epidemic drivers of SARS-CoV-2 dynamics in the Dominican Republic, an upper-middle income country of 10.8 million people, and assess the impact of the vaccination campaign implemented in February 2021 in saving lives and averting hospitalisations. We used an age-structured, multi-variant transmission dynamic model to characterise epidemic drivers in the Dominican Republic and explore counterfactual scenarios around vaccination coverage and population mobility. We fit the model to reported deaths, hospital bed occupancy, ICU bed occupancy and seroprevalence data until December 2021 and simulated epidemic trajectories under different counterfactual vaccination scenarios. We estimate that vaccination averted 5040 hospital admissions (95% CrI: 4750 - 5350), 1500 ICU admissions (95% CrI: 1420 - 1590) and 544 deaths (95% CrI: 488 - 606) in the first 6 months of the campaign. We also found that early vaccination with Sinovac-CoronaVac was preferable to delayed vaccination using a product with higher efficacy. We investigated the trade-off between changes in vaccination coverage and population mobility to understand how much relaxation of social distancing measures vaccination was able to 'buy' in the later stages of a pandemic. We found that if no vaccination had occurred, an additional decrease of 10-20% in population mobility would have been required to maintain the same death and hospitalisation outcomes. We found SARS-CoV-2 transmission dynamics in the Dominican Republic were driven by substantial accumulation of immunity during the first two years of the pandemic but that, despite this, vaccination was essential in enabling a return to pre-pandemic mobility levels without incurring considerable additional morbidity and mortality.

Deciphering Population Immune Dynamics of SARS-CoV-2

“…Further, a recent modeling study of SARS-CoV-2 transmission in the Dominican Republic demonstrated that the buildup of population immunity from mid-2021 increasingly limited transmission, independently affirming the role of immune restricted transmission in this setting. 19 Yet, while seemingly self-evident that individuals with higher levels of immune protection are less likely to be infected, and vice versa, without continuous infection monitoring that was not available for the current study, we are unable to unequivocally confirm this assumption. Other factors may influence or contribute to the normalization of immune markers.…”

Inference of epidemic dynamics in the COVID-19 era and beyond

“…eventual reopening with exit waves of infection [157]), and hence would have underestimated the benefits of vaccination. Subsequent work found that, given the severity of the Delta variant that caused waves in mid-2021, earlier vaccination with imperfect vaccine candidates (in this case because of reduced efficacy) was preferable in terms of hospitalisations and deaths averted to waiting months for other vaccine options [165].…”