Urgent needs of low-income and middle-income countries for COVID-19 vaccines and therapeutics.
Urgent needs of low-income and middle-income countries for COVID-19 vaccines and therapeutics.
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DOI：
10.1016/s0140-6736(21)00242-7
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发表时间：
2021-02-13
期刊：
影响因子：
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通讯作者：
Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force Members
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作者：
Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force Members
评论：柳叶刀。COM第397卷2021年2月13日参与国疫苗需求量的56320%。4大多数低收入和中等收入国家(低收入和中等收入国家)在获得和向其人口提供新冠肺炎疫苗和疗法方面面临困难。5 Covax将需要全球疫苗研究所、疫苗联盟、世卫组织和防疫创新联盟采取果断行动，在它们所服务的国家的支持下，并为疫苗购买提供资金，以确保世界各地的人们平等地获得新冠肺炎疫苗。6-8对于无法从Covax提供的新冠肺炎疫苗中受益的LMIC中的80%人群来说，需要资金来购买或捐赠。政府为应对新冠肺炎和更广泛的全球金融形势而采取的措施，导致重债国家的财政失衡加剧。9多国机构、金融机构和较富裕国家应考虑采取措施，为负债累累的低收入国家提供救济。世界银行、国际货币基金组织和其他机构需要领导一项国际倡议，动员对有需要的低收入国家的支持。许多低收入国家没有为其成年人口接种疫苗的既定平台。10尽管向保健和其他一线基本工作者提供新冠肺炎疫苗是可行的，但在一些地方，由于没有足够的机制来识别这类群体，很难有效地接触到所有老年人口和患有并存疾病的个人并接种两剂疫苗。各国政府和技术领导人在制定和解释循证疫苗优先排序决策时，需要使用透明、负责和不偏不倚的流程，同时也要建立对新冠肺炎疫苗的信心，并与所有利益攸关方接触。在大城市以外的LMIC，对新冠肺炎基因疫苗的超冷链要求可能是一个不可逾越的障碍。新冠肺炎疫苗的交付将需要投入大量资源、卫生保健人员和仔细规划，以避免机会成本，包括中断常规卫生服务和儿童基本疫苗接种覆盖率下降，这可能导致麻疹和其他疫苗可预防疾病的爆发。由于未能保持足够的儿童疫苗接种，2019年刚果民主共和国埃博拉疫情爆发后，死于麻疹的人数超过了死于埃博拉病毒的人数。11许多低收入国家的疫苗接种基础设施已经不足，全球有1970万未接种疫苗的婴儿，其中大部分在这些国家。12因此，必须在国际合作伙伴的支持下，现在就开始筹备在小岛屿发展中国家提供新冠肺炎疫苗的各个方面。
Comment www. thelancet. com Vol 397 February 13, 2021 56320% of the vaccine needs of participating countries. 4 Most low-income and middle-income countries (LMICs) face difficulties in accessing and delivering vaccines and therapeutics for COVID-19 to their populations. 5 COVAX will require decisive action by Gavi, the Vaccine Alliance, WHO, and the Coalition for Epidemic Preparedness Innovations (CEPI), supported by the countries they serve and with financing for vaccine purchasing, to ensure people worldwide have equitable access to COVID-19 vaccines. 6–8 For 80% of the populations in LMICs that will not benefit from COVAX-provided COVID-19 vaccines, finances for purchase or donations are needed. Government measures in response to COVID-19 and the broader global finan cial situation have led to increasing fiscal imbalances of heavily indebted countries. 9 Multi national agencies, financial institutions, and wealthier countries should consider measures that could provide relief to indebted LMICs. The World Bank, the International Monetary Fund, and others need to lead an international initiative to mobilise support for LMICs in need. Many LMICs do not have an established platform for vaccinating their adult populations. 10 Although it is feasible to deliver COVID-19 vaccines to health-care and other front-line essential workers, in some LMICs it will be difficult to effectively reach and vaccinate with two doses all elderly populations and individuals with co-morbidities, given insufficient mechanisms to identify such groups. Governments and technical leaders will need to use transparent, accountable, and unbiased processes when they make and explain evidence-based vaccine prioritisation decisions, while also building confidence in COVID-19 vaccines and engaging with all the stakeholders. The ultracold chain requirements of mRNA COVID-19 vaccines are likely to be an insurmountable hurdle in LMICs, outside of major cities. COVID-19 vaccine delivery will require considerable investment of resources, health-care staff, and careful planning to avoid opportunity costs, including a disruption of routine health services and a decline in essential childhood vaccination coverage, which could result in outbreaks of measles and other vaccine-preventable diseases. There were more deaths from measles than Ebola virus disease in 2019 in the aftermath of the Ebola outbreak in the Democratic Republic of theCongo, due to failure to maintain adequate childhood vaccinations. 11 The infrastructure for vaccination in many LMICs is already inadequate, as shown by the 19· 7 million under-vaccinated infants globally, most of whom are in these countries. 12 Thus, preparation for all aspects of COVID-19 vaccine delivery in LMICs must begin now with the support of international partners.