The herd-immunity threshold must be updated for multi-vaccine strategies and multiple variants

Abstract

Abstract Several vaccines with different efficacies and effectivenesses are currently being distributed across the world to control the COVID-19 pandemic. Having enough doses from the most efficient vaccines in a short time is not possible for all countries. Hence, policymakers may propose using various combinations of available vaccines to control the pandemic with vaccine-induced herd immunity by vaccinating a fraction of the population. The classic vaccine-induced herd-immunity threshold suggests that we can stop spreading the disease by vaccinating a fraction of the population. However, that classic threshold is defined only for a single vaccine and may be invalid and biased when we have multi-vaccine strategies for a disease or multiple variants, potentially leading policymakers to suboptimal vaccine-allocation policies. Here, we determine which combination of multiple vaccines may lead to herd immunity. We show that simplifying the problem and considering the vaccination of the population as a single-vaccine strategy whose effectiveness is the sample mean of all effectivenesses would not be ideal, because many multi-vaccine strategies with a smaller herd-immunity threshold can be proposed. We show that the herd-immunity threshold may vary due to changes in vaccine-uptake proportions. Moreover, we propose methods to determine the optimal combination of multiple vaccines in order to achieve herd immunity and apply our results to the issue of multiple variants. In addition, we determine a condition for reaching herd immunity in the presence of new emerging variants of concern. We show by example that new variants could influence our estimation of the vaccination reproduction number. It follows that the herd-immunity threshold must be updated not only when multi-vaccine strategies are used but also when multiple variants coexist in the population.