The challenges of distributing COVID-19 vaccinations.
The challenges of distributing COVID-19 vaccinations.
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DOI：
10.1016/j.eclinm.2020.100674
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发表时间：
2021-01
影响因子：
15.1
通讯作者：
Salisbury D
中科院分区：
文献类型：
--
作者：
Mills MC;Salisbury D
2020年11月9日，辉瑞/BioNTech报告了新冠肺炎疫苗的初步疗效结果，11月18日确认了95%的水平。11月16日，Moderna宣布95%的疗效，2天后，牛津和阿斯利康集团报告了在更大范围的组中的安全性和免疫原性。随着注意力转向部署，我们需要疫苗分发和实施的透明度。成功将取决于由政府、公司、卫生工作者和公众组成的复杂网络的合作。疫苗接种可能在2020年底开始，需要做好三件事：疫苗供应（冷藏、分发、注射器、针头）、实施疫苗接种的人员（接种员、记录工作人员）和接种疫苗的人员。如果不匹配，失败是不可避免的。COVID-19运动的步伐将由疫苗供应推动，因此实施工作需要相匹配。在许多国家，将按年龄、合并症、卫生保健工作者（HCWs）以及养老院和监狱居民和工作人员bbb分阶段部署优先群体。但核心问题依然存在。我们如何识别风险群体？如果他们出现在群众中心，我们怎么知道他们是否属于优先群体？我们将如何记录和追踪人们，特别是第二次注射的人？地方当局每周能在护理院或卫生保健中心真正为多少人接种疫苗？由于责任分工和部署细节尚未在英国和其他国家得到描述，因此有时间制定实施方案。英国政府和其他国家提出了三种选择：全科医生（全科医生，即医生）和初级保健网络、大规模疫苗接种诊所和移动卫生保健站点。目前还不清楚资源将如何分配给不同的群体，也不清楚谁会去全科医生那里，谁会去大型诊所。英国卫生部长最近讨论了每周100万剂的剂量，但这远远不够：这只是全科医生每周为季节性流感项目提供的剂量。去年，英格兰的全科医生为760万65岁及以上的人接种了疫苗，有危险因素的310万65岁以下的人接种了疫苗。最初的2000万剂足以满足这些人的需要，但每周100万剂只够每人在10周内接种第一剂。接下来的十周，我们将为同样的人接种疫苗。显然，该方案的速度和范围将取决于合同对象提供疫苗的情况。在英国，全科医生的护士估计在1260个初级保健网络中每天管理大约200À500次免疫接种。每天至少有一个站点长时间开放。如果我们取平均值（350人/天），那么每周将超过300万人。大型站点计划每个中心每天进行5000次免疫接种（每周35000次）；30家大型诊所每周将用完全部100万剂，直到供应大幅增加。流动小组将用于养老院和监狱。自私有化以来，英国各地养老院的数量一直难以估计，但英国的护理质量委员会（CQC）监管着15,000家养老院。最近的统计数据估计，仅在英格兰和威尔士，就有73,405名65岁以下的人和369,483名65岁及以上的人住在养老院。英国有117所监狱，人口达78977亿。除了运送到1.5万多个地点的后勤工作外，养老院和监狱人口还需要100万剂。医护人员也在优先名单上，英国估计有3276595名医护人员。非hcw重点工作人员（如教育、儿童保育、食品、交通、公共安全）合计…
On November 9, 2020, Pfizer/BioNTech reported the preliminary efficacy results for their COVID-19 vaccine, confirming levels of 95% on November 18. On November 16, Moderna announced 95% efficacy and 2 days later, the Oxford and AstraZeneca group reported safety and immunogenicity across a wider range of groups [1]. As attention turns to deployment, we need transparency about vaccine distribution and implementation. Success will hinge on collaboration of complex networks of government, companies, health workers and the public. Vaccinations could start by the end of 2020 and three things need to be in place: vaccine supplies (cold storage, distribution, syringes, needles), people to implement them (vaccinators, staff to document) and people to be vaccinated. If there is mismatch, failure is inevitable. The pace of the COVID-19 campaign will be driven by vaccine supplies, so implementation needs to be matched. Phased deployment of priority groups in many countries will take place by age, comorbidity, Health Care Workers (HCWs) and care home and prison residents and workers [2]. But core questions remain. How will we identify risk groups? If they turn up at a mass centre how will we know if they are in a priority group? How will we document and trace people, particularly for a second dose? How many people can local authorities really vaccinate in care homes or HCWs per week? Since the division of responsibility and details of deployment have not yet been described in the UK and beyond, there is time to shape implementation. Three options have been proposed by the UK government and other nations: general practitioners (GPs, ie, doctors) and primary care networks, mass vaccination clinics and mobile health care sites. It is unclear how resources will be split between groups or who will go to GPs versus mass clinics. The Health Secretary in the UK recently discussed having one million doses a week, but that won’t go far: it is only the same amount that GPs provide each week for their seasonal flu programmes. Last year, GPs in England vaccinated 7.6 million people 65 years and over, and 3.1 million less than 65 with risk factors. The first 20 million doses would suffice for these individuals but one million doses per week will only cover the first doses per person over ten weeks. The next ten weeks would be taken up vaccinating the same people. Clearly, the pace and extent of the programme will be driven by the availability of the vaccines from whoever is under contract.In the UK, GPs’ nurses are estimated to administer around 200À500 immunisations/day in 1260 primary care networks [3]. At least one site would be open for long hours, every days. If we take the average (350/day), it would be just over 3 million a week. Mass sites plan to undertake 5000 immunisations per centre/day (35,000/week)[3]; 30 mass clinics would use up all of one million doses per week until supplies increase considerably. Mobile teams will be used for care homes and prisons. The population of care homes across the UK has been difficult to estimate since they are privatised, but 15,000 are regulated by the Care Quality Commission (CQC) in England [4]. Recent statistics estimate that in England and Wales alone there are 73,405 individuals in care homes under the age of 65 and 369,483 65 and older [5]. There are 117 prisons in the UK with a population of 78,977 [6]. Leaving logistics of reaching over 15,000 locations aside, the care home and prison population would also need one million doses. HCWs are also on the priority list, estimated at 3,276,595 in the UK [7]. Non-HCW key workers (eg, education, childcare, food, transport, public safety) total …
DOI：
10.1016/s0140-6736(20)32466-1
发表时间：
2021-12-19
期刊：
Lancet (London, England)
影响因子：
--
作者：
Ramasamy MN;Minassian AM;Ewer KJ;Flaxman AL;Folegatti PM;Owens DR;Voysey M;Aley PK;Angus B;Babbage G;Belij-Rammerstorfer S;Berry L;Bibi S;Bittaye M;Cathie K;Chappell H;Charlton S;Cicconi P;Clutterbuck EA;Colin-Jones R;Dold C;Emary KRW;Fedosyuk S;Fuskova M;Gbesemete D;Green C;Hallis B;Hou MM;Jenkin D;Joe CCD;Kelly EJ;Kerridge S;Lawrie AM;Lelliott A;Lwin MN;Makinson R;Marchevsky NG;Mujadidi Y;Munro APS;Pacurar M;Plested E;Rand J;Rawlinson T;Rhead S;Robinson H;Ritchie AJ;Ross-Russell AL;Saich S;Singh N;Smith CC;Snape MD;Song R;Tarrant R;Themistocleous Y;Thomas KM;Villafana TL;Warren SC;Watson MEE;Douglas AD;Hill AVS;Lambe T;Gilbert SC;Faust SN;Pollard AJ;Oxford COVID Vaccine Trial Group
通讯作者：
Oxford COVID Vaccine Trial Group
影响因子：
34.3
作者：
Clark, Andrew;Jit, Mark;Eggo, Rosalind M.
通讯作者：
Eggo, Rosalind M.