This article is from WeChat official account:Nature Natural Research (ID: Nature-Research), the original author: Nidhi Subbaraman, title figure from: vision China

Whether you have to wait a few weeks—according to US President Trump’s statement; or a few months—according to the expectations of most medical experts, the highly anticipated new crown vaccine is not far from being approved .

However, there will be a shortage of vaccines at the beginning, which will not be alleviated until manufacturers expand production. Today, millions of people are at risk of infection every day, including medical workers, the elderly and people with other underlying diseases. Who should give priority to vaccination?

Countries are making plans: once the new crown vaccine is proven safe and effective, how to distribute it. Source: Natalia Kolesnikova/AFP/Getty

Recently, a strategic advisory group of the World Health Organization evaluated the preliminary guidance on global vaccine distribution and determined the population that should be given priority for vaccination. In addition, earlier in September, an expert group formed by the National Academy of Sciences, Engineering, and Medicine (NASEM) A draft was also announced.

The above two plans were formulated in response to the historical scale and unique epidemiological characteristics of the new crown epidemic, and experts spoke highly of both. They praised NASEM for considering the situation of minority ethnic groups from socio-economic factors in its guidance plan-these groups have been hit hard by the epidemic. On the other hand, some experts said that the World Health Organization’s program is still in its infancy, and more details need to be polished before it can be put into action.

“It is important for different groups to think about this issue together,” Eric Toner said. Toner is an emergency doctor and epidemiologist who did a similar plan at the Johns Hopkins Center for Health Security. He said that although these schemes are not the same, there are many unanimous points. “It is very good to be able to reach consensus on these issues.”

Priority channel

The current guidance plan of the World Health Organization only lists which groups of people should be vaccinated first, and NASEM’s goes a step further and lists the order of vaccination for different groups of people(See “Layered Method”).

According to NASEM’s draft, after medical workers, medically disadvantaged groups should be vaccinated first. They include the elderly living in crowded environments and suffering from multiple underlying diseases.(such as severe heart disease or diabetes) individuals whose underlying diseases make them prone to severe COVID-19 infection.

The program also prioritizes basic industry workers, such as public transportation practitioners, because this type of work will reach many people. Similarly, people living in certain crowded environments are also considered priority vaccination targets, such as those in homeless shelters and prisons.

Many countries have overall vaccine distribution plans, but they all target influenza and not the new coronavirus. These programs generally focus on children and pregnant women, while the distribution plan of the new crown vaccine is not, because most of the current vaccine trials do not include pregnant women, and the new crown virus is not as deadly to children as influenza. In fact, NASEM’s guidelines recommend that children be vaccinated in the final stages.

The World Health Organization’s plan is different from NASEM’s. It points out that government leaders should be vaccinated as soon as possible, but reminds that the key objects classified in this way should only be “strictly interpreted as a few individuals.”

“We are very worried that this group division may be exploited, that is, a large number of people deemed important require priority vaccination.” Ruth Faden said. She is a bioethicist at the Johns Hopkins Berman Institute for Bioethics and participated in the drafting of the World Health Organization’s guidelines.

Inflict heavy damage to the crowd

The above two programs have considered the vaccination of vulnerable groups. In view of some failed precedents, the World Health Organization’s program urges rich countries to ensure that poor countries can obtain vaccines early in the distribution of vaccines. During the 2009 H1N1 influenza pandemic, “when the world finally figured out how to distribute vaccines to low- and middle-income countries, the pandemic was over.”Faden said.

However, the World Health Organization’s plan does not suggest how countries should resolve the tension between domestic vaccine distribution and international vaccine distribution, said Angus Dawson, a bioethicist at the University of Sydney. He published a review earlier this year discussing the national vaccine distribution ethics during the pandemic1. In other words, Should countries that have been hit harder by the epidemic enjoy a larger distribution share in the initial stage of vaccine distribution, before vaccinating key populations in other countries?

NASEM is approved by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) commissioned to formulate a vaccine distribution plan; CDC will formulate the US government’s new crown vaccination plan, NIH is coordinating vaccine and therapy trialsTest. When entrusting NASEM to formulate a distribution plan, the heads of these two agencies requested that the plan clarify how to give priority to vaccinations for the “high-risk population”, including “ethnicity” who are affected by the epidemic and have a disproportionately higher mortality rate than other groups in the United States. And ethnic groups”.

The expert group believes that these groups are mainly in a disadvantaged position due to socioeconomic factors related to systemic discrimination. For example, they are engaged in high-risk jobs and live in high-risk areas. Therefore, their situation should be considered from this perspective, not because of Race or ethnic identity pulls them out individually.

“We are indeed working hard to ensure that the more affected people of color get vaccinated first-but this is because of the various factors that put them at risk, not because of their race and ethnic composition.” Helene Gayle said . She is the chairman and chief executive officer of the Chicago Community Trust, and co-chair of the NASEM Project Drafting Committee.

Faden said that the guidance recommendations echo current US concerns about racial inequality. “What I noticed when I read the report: Does this report touch on the current American culture? Does it touch on racism and other forms of structural inequality? The answer is yes. strong>” she said.

To this end, the NASEM expert team has drawn up a long list of basic workers who should be vaccinated first, including store clerks, bus passenger transport workers and postal personnel. The racial and ethnic groups that have been severely hit by the epidemic do indeed account for too much of these jobs.

NASEM’s plan proposes that when making vaccine allocation decisions in the United States, states should use the CDC’s Social Vulnerability Index(Social Vulnerability Index). This location-based tool is often used to guide the distribution of relief after a national disaster. It not only considers people’s living location, but also considers the particularly prominent sanitary conditions faced by blacks and indigenous people and other people of color.

Listen to comments

The Strategic Advisory Group of the World Health Organization will continue to update its guidance plan. It will first divide the order of vaccination for key groups, and then include actual data from vaccine trials, such as how effective a certain vaccine is in the elderly. Although this guidance is open to all member states of the World Health Organization, it will not be mandatory.

In the United States, the NASEM committee will release the final plan in October. Finally, the US Centers for Disease Control and Prevention will comprehensively consider the opinions of multiple parties and formulate its own national vaccine distribution plan on this basis-which is expected to be announced later this year.

By then, national public health departments, doctors, and pharmacies will all follow the guidelines when distributing vaccines—provided that the vaccine is proven safe and effective and the public is willing to get it.

Trump has been advocating that the vaccine should be in place in November, just in time for the U.S. election-but giving the impression that it is being promoted by others may hurt people’s trust in it, behavioral scientist at the University of Maryland Center for Health Equality Sandra Crouse Quinn said, “This will greatly compromise the effectiveness of the vaccine distribution plan.”

Dawson said that when actually implementing these plans, “you have to consider political factors.”

References:

1. Williams, J. H. & Dawson, A. BMC Med. Ethics 21, 40 (2020).

The original article titled Who gets a COVID vaccine first? Access plans are taking shape was published in the News section of Nature on September 17, 2020

© naturedoi: 10.1038/d41586-020-02684-9

This article is from WeChat official account:Nature Natural Research (ID: Nature-Research) , original author: Nidhi Subbaraman