Actionable lessons for the US COVID vaccine program.
Actionable lessons for the US COVID vaccine program.
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DOI：
10.1186/s13584-021-00452-2
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发表时间：
2021-02-19
影响因子：
4.5
通讯作者：
Freed GL
中科院分区：
文献类型：
--
作者：
Freed GL
当试图从以色列COVID-19疫苗的成功经验中为其他国家提供经验教训时，区分罗森文章中确定的可修饰和不可修饰成分是很重要的，美国可以从中学习的以色列计划中包括的两个具体的可修改组件是：（a）一个国家（b）疫苗分配和管理的战略（而不是以个别国家为基础的）和（B）一个运作良好的公共卫生基础设施。作为一个联邦政府，美国维持着一个往往复杂的州和国家权力和责任网络。联邦政府负责向制造商订购、支付及采购COVID疫苗。在设计COVID-19疫苗分配和管理计划的后续步骤时，特朗普政府决定依靠各州自己来确定如何最好地实施疾病控制和预防中心（CDC）提供的指导。这一战略导致了50个不同的计划和50个不同的疫苗剂量分发系统，所有这些都是在每个州的一级。各州的卫生部门既没有资金，也没有经验，也没有统一的专门知识来制定和执行这些计划。在国家一级以外分发疫苗的国家战略和提供疫苗的劳动力，与以色列发生的情况类似，将在全国范围内提供更高的效率和协调。美国公共卫生基础设施准备不足，人员不足，无法承担迅速提供超过4.5亿剂疫苗的责任，即使有疫苗供应。在全国各级政府中，未能充分投资于公共卫生的现象无处不在。自2008年经济衰退以来，州和地方卫生部门已经失去了超过38，000个工作岗位，州公共卫生部门的人均支出下降了16%，地方卫生部门的支出下降了18%。希望COVID-19将为美国敲响警钟，即需要制定应对公共卫生紧急情况的国家战略，以及维护良好的基础设施。
When attempting to provide lessons for other countries from the successful Israeli COVID-19 vaccine experience, it is important to distinguish between the modifiable and non-modifiable components identified in the article by Rosen, et al. Two specific modifiable components included in the Israeli program from which the US can learn are (a) a national (not individual state-based) strategy for vaccine distribution and administration and (b) a functioning public health infrastructure. As a federal government, the US maintains an often complex web of state and national authorities and responsibilities. The federal government assumed responsibility for the ordering, payment and procurement of COVID vaccine from manufacturers. In designing the subsequent steps in their COVID-19 vaccine distribution and administration plan, the Trump administration decided to rely on the states themselves to determine how best to implement guidance provided by the Centers for Disease Control and Prevention (CDC). This strategy resulted in 50 different plans and 50 different systems for the dissemination of vaccine doses, all at the level of each individual state. State health departments were neither financed, experienced nor uniformly possessed the expertise to develop and implement such plans. A national strategy for the distribution, and the workforce for the provision, of vaccine beyond the state level, similar to that which occurred in Israel, would have provided for greater efficiency and coordination across the country. The US public health infrastructure was ill-prepared and ill-staffed to take on the responsibility to deliver > 450 million doses of vaccine in an expeditious fashion, even if supply of vaccine was available. The failure to adequately invest in public health has been ubiquitous across the nation at all levels of government. Since the 2008 recession, state and local health departments have lost > 38,000 jobs and spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%. Hopefully, COVID-19 will be a wakeup call to the US with regard to the need for both a national strategy to address public health emergencies and the well-maintained infrastructure to make it happen.
影响因子：
4.5
作者：
Rosen B;Waitzberg R;Israeli A
通讯作者：
Israeli A