Coronavirus: The UK has achieved its most vulnerable vaccination goals, but who should be prioritized next?

The UK has achieved its goal of providing the first COVID-19 vaccine dose to the top four priority groups by mid-February. Vaccines are provided to all people over the age of 70, front-line medical and care staff, care home residents, and highly clinically vulnerable people. 15 million people I just took my first dose.

Joint Committee on Immunization and Immunization (JCVI) strategy Prioritized vaccination of those most likely to die of COVID-19 – Mainly elderly..This is in many countries World Health Organization (WHO), and has been widely supported so far.

However, while age is a good predictor of who will become seriously ill, the relationship is not perfectly linear. Absolutely, the risk of death under the age of 65 is relatively low.National Bureau of Statistics analysis Almost 90% of COVID-19 deaths were 65 years or older, as announced in October last year.

Nevertheless, JCVI has chosen to prioritize those who are well below this age threshold.Continue Lower the age group Until all people over the age of 50 are vaccinated. However, it is arguable whether this is the best strategy, or whether others need to start filtering into the vaccine queue.

When deciding how to assign a rare vaccine-and remember, it will probably take Until autumn Immunize everyone for supply restrictions – First you need to define the purpose of the vaccination program itself. It is estimated that vaccination of the JCVI priority group can prevent it. 99% of deaths from COVID-19 It also protects hospitals by reducing hospitalizations.

However, although these are clearly important objectives, they are not the only ones associated with vaccination programs. A Framework Created by the WHO Strategic Advisory Group of Vaccination Experts (Sage), it proposes several alternatives. Both of these can be pursued for good reason, but each requires a trade-off of priorities.

Potential strategies diverge

One option is to strategically distribute the vaccine to maintain essential services.Many US states are already doing this Including key workers At the first stage of vaccination.For example, in Iowa, people over the age of 65 Same priority As an emergency responder and teacher. This enhances important services, but can delay the protection of older people.

As in the UK, a 50-year-old office worker who works from home will be vaccinated before the teacher if the teacher is young, even for a year.Most outbreaks at school Related staffThere is a strong claim to protect teachers as soon as possible by moving them to the top of the queue.

The same principles can be extended beyond the education sector. In England One-third of the total workforce It is considered a major worker (transportation staff, food suppliers, emergency response personnel, etc.). They are at increased risk of being exposed to the virus because they cannot work from home. Occurrence at work Caused widespread confusion. Immunization based on occupational risks is not only an ethical obligation, but also a necessary step in resuming society.

Another purpose is to minimize the spread of the virus. Doing this becomes increasingly important as mortality decreases, as limiting infection is what ends the pandemic.New data is vaccine May reduce virus infection..

People who live or work in crowded areas Higher risk If your goal is to delay the infection by picking it up and inheriting it, make them a prime candidate for prioritization.Some people are more mobile, such as commuters and more socially active people Increased risk of infection..

It can also minimize the spread of the virus Reduce chances New viral variants emerge because mutations occur as the virus replicates. However, it is difficult to prevent transmissions when there is little ingestion into these highly connected groups.

The· WHO sage framework It also specifies that national priority plans should take into account disadvantaged groups.People with severe learning disabilities are now JCVI priority list, But otherwise, the UK guidance is ambiguous. Potential health inequality or exceptional situations are presented as a retrofit.

The “set of aggregates” that many people come into close contact with, such as homeless shelters, child and adult protection services, and prisons, are not on the UK priority list, Experience frequently Outbreak.In contrast, in Michigan, USA, people who live or work in such places Get vaccinated In the same phase as teachers and first responders, ahead of other major workers.

People from poor areas and ethnic minorities More vulnerable to infection..But the illness is often Young age With these groups May remain undiagnosed, That is, these groups can be overlooked if the prioritization is based solely on age or clinical risk.

The blockade also had a disproportionate impact on poor areas. Low-income group Most of the workforce In the most devastated sectors of the economy, such as retail, hospitality and private transportation. Early vaccination can protect these groups not only from infection, but also from socio-economic devastation.

After all, there is no gold standard way to assign the rare COVID-19 vaccine. The first decision we make to protect is the product of selected public health goals and social value judgments, and we can file proceedings against all the groups mentioned. JCVI’s age-based strategy is simple and effective in preventing death and protecting the healthcare system. Nevertheless, as vaccine deployments progress, more subtle strategies can be adopted that offer alternative benefits.

Vageesh Jain, NIHR Academic Clinical Fellow of Public Health Medicine, UCL And Paula Roguery, Professor of Health Economics, UCL

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