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强生疫苗引发医疗公平新问题:谁应该接种哪种疫苗?

强生疫苗引发医疗公平新问题:谁应该接种哪种疫苗?

ARIC JENKINS 2021年02月19日
随着强生公司的疫苗有望上市,讨论又增加了一个维度:谁应该接种哪种疫苗?

从美国开始接种新冠肺炎疫苗至今已经两个多月了,在这个混乱的过程中,始终存在一个核心争议:谁应该第一批接种疫苗?老年人、医疗上的弱势群体、必要岗位工作人员或者是任何一个真正愿意打这玩意儿的人?人们一直在这几个答案间来来回回。现在,随着强生公司(Johnson & Johnson)的疫苗有望上市,讨论又增加了一个维度:谁应该接种哪种疫苗?

强生公司的疫苗尚未获得美国食品和药物管理局的批准,但一旦获批用于紧急使用,明年3月就能开始出货。从临床试验的结果来看,强生的疫苗表面上与已获批准的莫德纳(Moderna)和辉瑞(Pfizer)疫苗有显著不同。

强生的疫苗似乎更方便:可以储存在普通的冰箱里,只需接种一针即可;莫德纳和辉瑞的疫苗必须储存在可保证零下70摄氏度的专用冰柜中,需注射两剂,中间间隔数周。但莫德纳和辉瑞的疫苗似乎更有效:他们的疫苗预防中重症的有效性约为95%;强生疫苗在美国的试验中,中重症防护效果为72%,在南非仅为57%(在南非,一种高传染性的新冠病毒变种导致病例激增)。

需要注意的是,流行病学家仍然认为72%的结果相当好,而且在强生公司的试验中,没有出现一起死亡病例。话虽如此,考虑到美国存在系统性的医疗歧视问题,不难想象某些社区会因为只得到“较弱”的疫苗而愤愤不平。

新冠肺炎对有色人种的影响尤为严重。据《大西洋月刊》(Atlantic)的新冠肺炎追踪项目统计,全美范围内,黑人的死亡率是白人的1.5倍,在美国迄今45.6万例新冠死亡病例中占大约6.4万例。原住民和西班牙裔的死亡率也高于美国白人。

有几方面的原因,其中包括在必要岗位工作者中,少数族裔美国人的占比过高,因此暴露在病毒中的风险也更高。此外,就非裔美国人而言,他们的疫苗接种率也远低于白人。本周早些时候,美国疾病控制与预防中心发布了一份报告,在接种过疫苗的美国人中,大约仅有5.4%是黑人,而黑人在美国人口中占比为13%。非西班牙裔美国白人的接种人数按照其在总人口中的占比稳步上升。

这种不平等很大程度上归结于缺乏医疗资源,以及对联邦政府医疗系统的不信任。

“要想消除这些障碍,无论是沟通上还是操作上都很艰。”凯萨家庭基金会(Kaiser Family Foundation)负责全球卫生政策的副主任乔希·米肖德说,“对新疫苗及其将如何适应总体疫苗战略的担忧是不无道理的。我们手头每一种疫苗的优劣都截然不同,强生公司的产品更是如此。”

米肖德说,沟通的关键在于要摒弃任何“低级”或“高级”疫苗的概念。在降低住院率上,强生公司疫苗的防护效果也非常可观,可以保护人们免于新冠肺炎重症,从而为患有其他严重疾病的患者腾出床位。而且,接种强生疫苗的人中没有一人死亡。

“如果我们关注的是减少住院和死亡人数,无论能拿到哪种疫苗,接种就行。”乔治华盛顿大学(George Washington University)健康管理和政策教授杰弗里·利瓦伊说,“你接种的疫苗就是最好的疫苗。”

利瓦伊说,强生公司疫苗单次注射而且可以使用普通冰箱储存的优势,可以造福交通不便的农村地区和没有大功率冰柜的社区。

“这样两相抵消就平衡了。”他说,“只需一次注射的便利有利于更多人得到疫苗。目前最重要的公平问题是供应问题。我们需要为更多的人提供更多疫苗。但感觉我们似乎无法满足这么人的接种需求,因此任何可以提高疫苗供应的措施都会有所帮助。”

不可避免的是,尤其是一开始,有些社区或许只有一种疫苗选择。但公共卫生专家说,总的来说,随着疫苗接种计划不断改善,强生公司的疫苗(如果获批用于紧急使用)以及其他新疫苗(如阿斯利康公司和牛津大学共同研发的疫苗)应该可以多管齐下,为尽可能多的人接种。像强生这样的单针疫苗可能被用于临时大规模疫苗接种诊所。莫德纳和辉瑞等其他有效性更强的疫苗可能会优先用于医疗上特别脆弱的人群。“需要通过多种形式共同接种,”利瓦伊说。

“如果有人给我提供强生公司的疫苗,我会毫不犹豫地接受。”米肖德说,“这才是我们想传达给公众的信息。并不是把劣质产品分给某些人,把优质产品分给另外一些人。我们必须积极驳斥这种观点。”(财富中文网)

译者:Agatha

从美国开始接种新冠肺炎疫苗至今已经两个多月了,在这个混乱的过程中,始终存在一个核心争议:谁应该第一批接种疫苗?老年人、医疗上的弱势群体、必要岗位工作人员或者是任何一个真正愿意打这玩意儿的人?人们一直在这几个答案间来来回回。现在,随着强生公司(Johnson & Johnson)的疫苗有望上市,讨论又增加了一个维度:谁应该接种哪种疫苗?

强生公司的疫苗尚未获得美国食品和药物管理局的批准,但一旦获批用于紧急使用,明年3月就能开始出货。从临床试验的结果来看,强生的疫苗表面上与已获批准的莫德纳(Moderna)和辉瑞(Pfizer)疫苗有显著不同。

强生的疫苗似乎更方便:可以储存在普通的冰箱里,只需接种一针即可;莫德纳和辉瑞的疫苗必须储存在可保证零下70摄氏度的专用冰柜中,需注射两剂,中间间隔数周。但莫德纳和辉瑞的疫苗似乎更有效:他们的疫苗预防中重症的有效性约为95%;强生疫苗在美国的试验中,中重症防护效果为72%,在南非仅为57%(在南非,一种高传染性的新冠病毒变种导致病例激增)。

需要注意的是,流行病学家仍然认为72%的结果相当好,而且在强生公司的试验中,没有出现一起死亡病例。话虽如此,考虑到美国存在系统性的医疗歧视问题,不难想象某些社区会因为只得到“较弱”的疫苗而愤愤不平。

新冠肺炎对有色人种的影响尤为严重。据《大西洋月刊》(Atlantic)的新冠肺炎追踪项目统计,全美范围内,黑人的死亡率是白人的1.5倍,在美国迄今45.6万例新冠死亡病例中占大约6.4万例。原住民和西班牙裔的死亡率也高于美国白人。

有几方面的原因,其中包括在必要岗位工作者中,少数族裔美国人的占比过高,因此暴露在病毒中的风险也更高。此外,就非裔美国人而言,他们的疫苗接种率也远低于白人。本周早些时候,美国疾病控制与预防中心发布了一份报告,在接种过疫苗的美国人中,大约仅有5.4%是黑人,而黑人在美国人口中占比为13%。非西班牙裔美国白人的接种人数按照其在总人口中的占比稳步上升。

这种不平等很大程度上归结于缺乏医疗资源,以及对联邦政府医疗系统的不信任。

“要想消除这些障碍,无论是沟通上还是操作上都很艰。”凯萨家庭基金会(Kaiser Family Foundation)负责全球卫生政策的副主任乔希·米肖德说,“对新疫苗及其将如何适应总体疫苗战略的担忧是不无道理的。我们手头每一种疫苗的优劣都截然不同,强生公司的产品更是如此。”

米肖德说,沟通的关键在于要摒弃任何“低级”或“高级”疫苗的概念。在降低住院率上,强生公司疫苗的防护效果也非常可观,可以保护人们免于新冠肺炎重症,从而为患有其他严重疾病的患者腾出床位。而且,接种强生疫苗的人中没有一人死亡。

“如果我们关注的是减少住院和死亡人数,无论能拿到哪种疫苗,接种就行。”乔治华盛顿大学(George Washington University)健康管理和政策教授杰弗里·利瓦伊说,“你接种的疫苗就是最好的疫苗。”

利瓦伊说,强生公司疫苗单次注射而且可以使用普通冰箱储存的优势,可以造福交通不便的农村地区和没有大功率冰柜的社区。

“这样两相抵消就平衡了。”他说,“只需一次注射的便利有利于更多人得到疫苗。目前最重要的公平问题是供应问题。我们需要为更多的人提供更多疫苗。但感觉我们似乎无法满足这么人的接种需求,因此任何可以提高疫苗供应的措施都会有所帮助。”

不可避免的是,尤其是一开始,有些社区或许只有一种疫苗选择。但公共卫生专家说,总的来说,随着疫苗接种计划不断改善,强生公司的疫苗(如果获批用于紧急使用)以及其他新疫苗(如阿斯利康公司和牛津大学共同研发的疫苗)应该可以多管齐下,为尽可能多的人接种。像强生这样的单针疫苗可能被用于临时大规模疫苗接种诊所。莫德纳和辉瑞等其他有效性更强的疫苗可能会优先用于医疗上特别脆弱的人群。“需要通过多种形式共同接种,”利瓦伊说。

“如果有人给我提供强生公司的疫苗,我会毫不犹豫地接受。”米肖德说,“这才是我们想传达给公众的信息。并不是把劣质产品分给某些人,把优质产品分给另外一些人。我们必须积极驳斥这种观点。”(财富中文网)

译者:Agatha

In the seven weeks or so since public COVID-19 vaccinations began in the U.S., a central question has loomed over the disarrayed process: Who should get the vaccine first? Debates have zigzagged among the elderly, the medically vulnerable, essential workers, or maybe just anyone who’s actually willing to get the dang thing. Now, with the potential arrival of a new promising vaccine from Johnson & Johnson, another layer has been added to the discourse: Who should get which vaccine?

Johnson & Johnson’s vaccine has not yet been authorized by the Food and Drug Administration, but it could start shipping as soon as March if federal regulators approve its emergency application. On the surface, based on clinical trials, there are some significant differences from the already authorized Moderna and Pfizer vaccines.

Johnson & Johnson’s vaccine appears more convenient: It can be stored in a normal refrigerator and requires just a single shot; Moderna’s and Pfizer’s must be stored in special freezers kept at negative 70 degrees Celsius and require two doses, with a period of several weeks in between. But Moderna’s and Pfizer’s vaccines appear more effective: Their vaccines are roughly 95% effective at preventing moderate to serious illness; Johnson & Johnson’s rate was 72% in its U.S. trial, and just 57% in South Africa, where a highly contagious variant of COVID-19 has led to a spike in cases.

It’s important to note that epidemiologists still consider 72% efficacy quite good, and that there wasn’t a single death reported in Johnson & Johnson’s trial. Still, given the history of systemic health care discrimination in the U.S., it’s not difficult to imagine a scenario in which certain communities feel aggrieved for only getting access to the “weaker” vaccine.

COVID-19 affects communities of color disproportionately. Nationwide, Black people have died at 1.5 times the rate of white people, accounting for roughly 64,000 of the 456,000 COVID-related deaths in the country to date, according to the Atlantic’s COVID Tracking Project. Indigenous Americans and Hispanic communities suffer higher death rates than white Americans, as well.

There are several reasons for this, among them that minority Americans are disproportionately essential workers, increasing their risk of exposure to the virus. In the case of Black Americans, they also are being vaccinated at much lower rates than their white counterparts. Earlier this week, the CDC published a report estimating that only 5.4% of vaccinated Americans are Black, even though they make up 13% of the population. Non-Hispanic white Americans are pacing on track with their share of the population.

Much of that disparity comes down to a lack of access, as well as a historical mistrust in the federal government’s medical system.

“It’s going to be a challenging communications and operational endeavor to try and square all of these circles here,” said Josh Michaud, associate director for global health policy at the Kaiser Family Foundation. “It’s valid to raise the concerns about the new vaccine and how they will fit into the overall strategy. Each that we have, particularly Johnson & Johnson’s, presents strengths and weaknesses that are remarkably different.”

The key to that communication, Michaud said, is to dispel any notion of an “inferior” or “superior” vaccine. In terms of preventing hospitalizations—sparing people from serious COVID symptoms and freeing up beds for patients with other serious medical conditions—the Johnson & Johnson vaccine still appears very effective. And not one person who took its vaccine died.

“If your focus is reducing hospitalizations and deaths, you take the vaccine you can get,” said Jeffrey Levi, a professor of health management and policy at George Washington University. “The best vaccine is the one you get in your arm.”

Levi said that Johnson & Johnson’s single-shot vaccine and the ability to store it in a standard refrigerator would be beneficial to isolated, rural communities and those without access to high-powered freezers.

“The equity balances out,” he said. “The simplicity of only requiring one dose increases the likelihood of getting a vaccine. The most important equity issue right now is supply. We need more vaccines to reach more people. There’s a feeling we’re not able to vaccinate a number of people we need to vaccinate—anything to increase that helps.”

Inevitably, some communities—especially in the beginning—may find themselves with access to only one of the vaccines. But in general, as distribution improves, Johnson & Johnson’s—if it’s approved for emergency use by the FDA—as well as other newcomers like AstraZeneca’s Oxford University vaccine, should be used in a multipronged strategy to vaccinate as many people as possible, public health experts say. A single-shot vaccine like Johnson & Johnson’s might be used for pop-up mass vaccination clinics. Others with more effectiveness, like Moderna’s and Pfizer’s, might be prioritized for especially medically vulnerable populations. “You need multiple forms of outreach,” said Levi.

“If I’m offered the Johnson & Johnson vaccine, I’d take it in a heartbeat,” said Michaud. “That’s the kind of communication you want to get across. It’s not really a matter of sending a poor product to certain people and a good product to others. We have to actively fight against that perception.”

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