Using data to improve public health: COVID-19 secondment

新型冠状病毒疫苗的开发和实施一直是旨在减轻持续大流行影响的主要公共卫生策略之一。多种疫苗的安全性和有效性已在大型III期临床试验中得到证实。然而，关于这些疫苗的实际使用仍然存在关键的不确定性，包括：（i）疫苗诱导的保护在不同亚群中的强度和持久性，包括处于严重COVID-19特定风险的群体;（ii）给药间隔对疫苗有效性的影响;（iii）疫苗接种的时间间隔。和（iii）疫苗诱导的保护作用可能被自然SARS-CoV-2感染增强的程度（在接种疫苗之前或之后）。解决这些不确定性对于为有关额外COVID-19疫苗剂量的必要性、最佳时机和可能影响的政策决策提供信息至关重要。我的借调将利用OpenSAFELY --一个用于分析英国电子健康记录数据的安全开源软件平台--来解决有关实际COVID-19疫苗实施和有效性的关键问题。我将与伦敦卫生与热带医学院和牛津大学的研究人员合作，评估COVID-19疫苗在关键风险群体中的覆盖率，包括受慢性肾脏疾病影响的个体（目标1）。然后，我将根据初始剂量（例如RNA疫苗与载体疫苗）和加强剂量接受的疫苗，比较这些风险组中的疫苗有效性，特别强调异源“混合匹配”计划对疫苗性能的潜在影响（目标2）。最后，我将探讨几个关键因素对疫苗保护强度和持久性的影响，包括剂量间隔和自然感染（目标3）。在此过程中，该项目将大规模应用真实世界的电子健康数据，以解决有关正在进行的COVID-19疫苗推广的重要证据缺口。

The development and implementation of COVID-19 vaccines has been among the key public health strategies aiming to mitigate the fallout of the ongoing pandemic. The safety and efficacy of multiple vaccines has been established in large Phase III clinical trials. However, key uncertainties remain regarding the real-world use of these vaccines, including: (i) the strength and durability of vaccine-induced protection in different subpopulations, including groups at particular risk of severe COVID-19; (ii) the influence of dosing interval on vaccine effectiveness; and (iii) the extent to which vaccine-induced protection might be augmented by natural SARS-CoV-2 infection (either before or after vaccination). Addressing these uncertainties will be essential to inform policy decisions regarding the necessity, optimal timing, and likely impact of additional COVID-19 vaccine doses.My secondment will harness OpenSAFELY - a secure, open-source software platform for the analysis of electronic health record data within the UK - to address key questions regarding real-world COVID-19 vaccine implementation and effectiveness. Working with researchers at the London School of Hygiene & Tropical Medicine and Oxford University, I will evaluate COVID-19 vaccine coverage in key risk groups, including individuals affected by chronic kidney disease (Objective 1). I will then compare vaccine effectiveness in these risk groups according to the vaccines received for initial doses (e.g. RNA vs vectored vaccines) and booster doses, with a particular emphasis on the potential impact of heterologous 'mix-and-match' schedules on vaccine performance (Objective 2). Finally, I will explore the impact of several key factors on the strength and durability of vaccine protection, including dose interval and natural infection (Objective 3). In doing so, the project will apply real-world electronic health data at scale to address important evidence gaps regarding the ongoing COVID-19 vaccine roll-out.