Optimized delay of the second COVID-19 vaccine dose reduces ICU admissions

Proc Natl Acad Sci U S A. 2021 Aug 31;118(35):e2104640118. doi: 10.1073/pnas.2104640118.


Slower than anticipated, COVID-19 vaccine production and distribution have impaired efforts to curtail the current pandemic. The standard administration schedule for most COVID-19 vaccines currently approved is two doses administered 3 to 4 wk apart. To increase the number of individuals with partial protection, some governments are considering delaying the second vaccine dose. However, the delay duration must take into account crucial factors, such as the degree of protection conferred by a single dose, the anticipated vaccine supply pipeline, and the potential emergence of more virulent COVID-19 variants. To help guide decision-making, we propose here an optimization model based on extended susceptible, exposed, infectious, and removed (SEIR) dynamics that determines the optimal delay duration between the first and second COVID-19 vaccine doses. The model assumes lenient social distancing and uses intensive care unit (ICU) admission as a key metric while selecting the optimal duration between doses vs. the standard 4-wk delay. While epistemic uncertainties apply to the interpretation of simulation outputs, we found that the delay is dependent on the vaccine mechanism of action and first-dose efficacy. For infection-blocking vaccines with first-dose efficacy ≥50%, the model predicts that the second dose can be delayed by ≥8 wk (half of the maximal delay), whereas for symptom-alleviating vaccines, the same delay is recommended only if the first-dose efficacy is ≥70%. Our model predicts that a 12-wk second-dose delay of an infection-blocking vaccine with a first-dose efficacy ≥70% could reduce ICU admissions by 400 people per million over 200 d.

Keywords: control; outbreaks; strategies; vaccination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Brazil / epidemiology
  • COVID-19 / epidemiology
  • COVID-19 / immunology
  • COVID-19 / prevention & control*
  • COVID-19 Vaccines / administration & dosage*
  • COVID-19 Vaccines / supply & distribution
  • Hospitalization / statistics & numerical data*
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • SARS-CoV-2 / immunology*
  • Time-to-Treatment / standards*
  • Treatment Outcome
  • Vaccination / methods*
  • Vaccination / statistics & numerical data


  • COVID-19 Vaccines