Viewpoint: vaccine inequity in the spotlight.
Viewpoint: vaccine inequity in the spotlight.
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DOI：
10.1136/archdischild-2021-322940
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发表时间：
2022-12
影响因子：
5.2
通讯作者：
中科院分区：
文献类型：
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作者：
疫苗不平等从未像过去几个月那样受到公众的关注。在6月的七国集团会议上，COVID-19疫苗供应方面的严重不公平现象在很大程度上是由国家自身利益驱动的。尽管如此，在许多低收入非洲国家，只有不到2%的人口接种了COVID-19疫苗，而生活在大多数高收入环境中的一半以上的人至少接种了一剂疫苗，在许多情况下接种了两剂疫苗。尽管风险-效益分析不太确定，但越来越多的国家正在为12岁以上的儿童接种疫苗，并且在没有迹象表明将广泛需要这些疫苗的情况下，正在储存加强免疫的疫苗。这两种方法都与世卫组织目前的立场直接冲突。为解决这些不平等问题而提出的主要论点集中在自我保护（“在所有人都安全之前，没有人是安全的”）和确保全球经济复苏。各国将捐赠“剩余”疫苗的期望也在很大程度上取代了疫苗公平的前提。虽然可能只有最终诉诸国家利益的论点才具有必要的吸引力，但它们主要针对COVID-19大流行疫苗接种，因此没有将当前的不平等放在更广泛的背景下考虑。这样的背景是至关重要的，因为最终目标肯定是尽量减少大流行造成的所有疫苗可预防的超额死亡，而不仅仅是直接归因于SARS-CoV-2感染的死亡。模拟研究和世卫组织政策建议支持在大流行期间维持常规儿童免疫接种。12然而，撒哈拉以南非洲许多国家的疫苗规划很脆弱；能力有限，无法弥补疫苗供应的延误或对工作人员和资源的额外需求，而这两种情况在当前大流行期间都达到了前所未有的水平。对维持人口免疫力和应对疫情至关重要的大规模疫苗接种运动，包括麻疹和脊髓灰质炎疫苗接种，也被推迟了。此外，由于此类规划原因导致的疫苗接种覆盖率下降，正因流传的错误信息和谣言而成倍增加，例如，谣言称正在非洲部署COVID-19疫苗以控制人口。3 .根据我们自己在冈比亚的经验，这种谣言对疫苗的总体信心产生了负面影响，从而对其他疫苗的吸收产生了负面影响。鉴于这些因素，如果不与解决当前COVID-19疫苗供应不平等的努力结合起来考虑，去年《2030年免疫议程》（本身就是“不让任何一个人掉队”的路线图）所规定的解决撒哈拉以南非洲地区在获得拯救生命的疫苗方面存在的不平等现象的进展将会逆转。每年仍有数十万5岁以下儿童死于疫苗可预防的肺炎球菌病和b型流感嗜血杆菌病以及轮状病毒腹泻。2019年，全球可预防的麻疹死亡人数再次增加到20万以上，由于人口流动和社会混合减少，加上监测受到损害，预计大流行期间报告病例的短暂减少将会反弹。由于疫苗衍生脊髓灰质炎病毒病例迅速增加，特别是在西非，根除脊髓灰质炎也处于关键时刻。今年6月启动的《2022-2026年消除脊髓灰质炎战略》……
Vaccine inequity has never before been in the public eye as it has been in the last months. The profound inequities in COVID-19 vaccine supply which have been allowed to develop, driven largely by perceived national self-interest, reached the world stage at the G7 meeting in June. Despite this, less than 2% of the population of many lowincome African countries have been vaccinated against COVID-19, while more than half of those living in most high-income settings have received at least one, and in many case two vaccine doses. An increasing number of countries are now vaccinating children from the age of 12, despite risk–benefit analysis being less certain, and are stock-piling vaccines for booster immunisations, in the absence of indication that these will be required on widespread basis. Both approaches are in direct conflict with the current position of the WHO. The primary arguments that have been put forward to address these inequities have focused on self-protection (‘Nobody is safe until everybody is safe’) and on ensuring global economic recovery. An expectation that counties will donate ‘surplus’ vaccines has also largely replaced the premise of vaccine equity. Although it may be that only arguments appealing ultimately to national self-interest have the necessary traction, they are largely specific to pandemic COVID-19 vaccination, thus do not put the current inequalities in their wider context. Such context is essential, given the ultimate aim must surely be to minimise all excess vaccine-preventable deaths due to the pandemic, rather than solely those deaths directly attributable to SARS-CoV-2 infection.Modelling studies and WHO policy recommendations have supported sustaining routine childhood immunisation throughout the pandemic. 1 2 However, vaccine programmes in many countries in sub-Saharan Africa are fragile; having limited capacity to cover for either delays in vaccine supply, or for having additional demands placed on staff and resources—both of which have occurred to an unprecedented level during the current pandemic. Mass vaccination campaigns, including for measles and polio, which are essential to maintaining population immunity and to outbreak response, have also been delayed. In addition, reductions in vaccination coverage for such programmatic reasons are being multiplied by misinformation and rumours circulating, for example, suggesting COVID-19 vaccines are being deployed in Africa for the purpose of population control. 3 From our own experience in The Gambia, such rumours are having a negative impact on vaccine confidence overall and hence on the uptake of other vaccines. Given these factors, progress addressing the pre-existing inequities in the availability of life-saving vaccines across sub-Saharan African, as set out last year in the Immunization Agenda 2030—itself a roadmap to ‘leave no one behind’4—will be reversed if not considered in tandem with efforts to address the current inequity in COVID-19 vaccine supply. Hundreds of thousands of under 5 years old continue to die annually from vaccine-preventable pneumococcal and Haemophilus influenzae type b disease, and from rotavirus diarrhoea. The number of preventable deaths from measles increased to beyond 200 000 again globally in 2019 and any transient reduction in cases reported during the pandemic due to reduced population movement and social mixing, combined with compromised surveillance, are expected to rebound. Polio eradication is also at a critical juncture as cases of vaccine-derived poliovirus increase rapidly, particularly in West Africa. The 2022–2026 Polio Eradication Strategy, launched in June this year …
影响因子：
34.3
作者：
Abbas, Kaja;Procter, Simon R.;Flasche, Stefan
通讯作者：
Flasche, Stefan
DOI：
10.11604/pamj.2021.38.3.27401
发表时间：
2021
期刊：
The Pan African medical journal
影响因子：
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作者：
Afolabi AA;Ilesanmi OS
通讯作者：
Ilesanmi OS