由于 SARS-CoV-2 病毒不断进化的性质，需要适应新出现的流行变种的 COVID-19 疫苗才能更好地保护人群。南非人口按年龄和风险进行分层（由糖尿病、肥胖等合并症定义） 、吸烟、癌症和哮喘）和艾滋病毒状况。根据文献和南非监测数据得出的特定年龄输入，使用马尔可夫决策树模型估计了基于年龄、风险和艾滋病毒状况的不同疫苗接种策略的结果。估计对老年人和患有合并症的人进行疫苗接种避免了 111,179 例感染、18,281 例住院治疗和 3,868 例死亡，直接和间接成本分别节省 12.6 亿南非兰特（6,700 万美元）和 32.05 亿南非兰特（1.7 亿美元）。当考虑针对老年人和艾滋病毒人群的策略时，也得到了类似的结果。将疫苗接种范围扩大到 75% 的标准风险人群，与之前相比，预防了更多的感染 (401%)、住院治疗 (167%) 和死亡 (67%)，并增加了直接 (232%) 和间接 (455%) 成本节省实施广泛的疫苗接种策略，使用适合南非流行的流行变种的疫苗，将带来重大的公共卫生和经济收益。

COVID-19 vaccines adapted to newly emerging circulating variants are necessary to better protect the population due to the evolving nature of the SARS-CoV-2 virus.The South African population was stratified by age and risk (defined by comorbidities such as diabetes, obesity, smoking, cancer, and asthma), and HIV status. The outcomes of different vaccination strategies based on age, risk, and HIV status were estimated using a Markov-decision tree model based on age-specific inputs derived from the literature and South African surveillance data.Vaccinating older adults and those with comorbidities was estimated to avert 111,179 infections 18,281 hospitalizations, and 3,868 deaths, resulting in savings of ZAR 1,260 million (USD 67 million) and ZAR 3,205 million (USD 170 million) in direct and indirect costs, respectively. Similar results were obtained when considering strategies targeting older adults and the HIV population. Expanding vaccination to 75% of the standard-risk population prevented more infections (401%), hospitalizations (167%), and deaths (67%) and increased the direct (232%) and indirect (455%) cost savings compared to the base case.Implementing widespread vaccination strategies that utilize a vaccine adapted to the prevailing circulating variant in South Africa would result in significant public health and economic gains.