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In the race to develop a Covid-19 vaccine, much attention has been paid to the types of vaccines being developed and their progress through the various stages of the clinical trial. Much less attention has been paid to what happens after a vaccine is approved by regulators.
As recognized by a US scientific committee, governments need to start planning how they will distribute a vaccine efficiently and fairly, because when a vaccine is approved, most countries will not have enough doses to vaccinate everyone.
Governments must make decisions now so that vaccine allocation can begin as soon as one is available. Without a clear plan, valuable time will be lost and governments may be forced to make quick decisions that fail to harness the full potential of a vaccine.
So what are these decisions that governments must make? First, should they allow the vaccine to be purchased privately or only through public channels, such as a country’s national health service? In most countries, people can get preferential access to most medicines by purchasing them privately. However, it can be said that the pandemic is similar to a war situation in which vital goods must be rationed with a limited supply.
Next, what criteria should be used to decide how to allocate the initially limited doses of the vaccine? Prioritizing who should get the vaccine will involve balancing different, sometimes conflicting, considerations. Key considerations should include: reducing the most serious health effects of Covid-19, reducing the transmission rate, and allowing the economy to return to normal.
The assignment must also be fair. This is especially important considering that Covid-19 especially affects disadvantaged groups. Therefore, vaccination programs could also be evaluated according to the probability that existing inequalities will increase or decrease.
Governments also need to plan what to do if there are not enough doses to cover all people who are assigned the same priority. Arguably the fairest way to do this would be to hold a lottery.
Developing a framework
Vaccination of a particular group will have a variety of effects. It will help prevent severe Covid-19 among those vaccinated. It will reduce the spread of the virus because those vaccinated will be less likely to transmit the virus to other people. And it can allow people to return to work safely, helping the economy return to normal.
Governments should assess the likely size of these effects, based on the best evidence, when considering how high a priority a particular group should have. Fortunately, more and more tests are available to help. With the help of scientists, governments must now gather all this evidence and create a framework, as we recommended in our recent article, to understand the likely benefits of adopting different vaccine allocation strategies.
The framework should include an assessment of the relative benefits of vaccinating different groups. For example, predicting the overall benefits of vaccinating people working in the retail and service sector may involve taking into account the health benefits of staff, the social health benefits through less transmission to buyers, and benefits for the economy, such as allowing more stores to open.
Similarly, those caring for elderly family members may get only a small individual health benefit, but their vaccine can prevent Covid-19 in the people they care for and allow them to return to their office without worrying so much about passing the virus on to their elderly. . loved ones.
Decisions governments must make about the allocation of a vaccine:
Source: Roope and Clarke
Beyond combining research evidence to assess the likely benefits of vaccination strategies, governments and researchers could seek public opinion on key aspects of vaccine distribution. Scientists have long advocated for public participation in medical research.
Public input could inform the extent to which a vaccination strategy prioritizes health benefits over broader benefits, such as enabling a safe return to schools and protecting jobs and the economy. In addition, public opinion could inform whether the private sale of a vaccine should be prohibited and whether it could be distributed through lotteries among people with the same need.
In addition to developing clear criteria on which to base allocation, many practical problems will need to be solved about vaccine implementation, such as the cost and efficiency of administering it in the workplace rather than in hospitals and clinics.
While governments must make decisions at the national level, there must also be a coordinated international effort. To date, high-income countries have already ordered more than two billion doses of vaccines. International efforts to purchase a similar number of doses for low- and middle-income countries are struggling to gain ground. The infectious nature of Covid-19 means that it is in all countries’ interest to ensure that the pandemic is contained globally.
The race to defeat Covid-19 will be won in stages. After developing a vaccine, the next challenge will involve your assignment. We should prepare for this stage now. As most athletes will attest, preparation is the key to good performance. – The conversation
Laurence Roope is Principal Investigator in Health Economics at Oxford University, while Philip Clarke is Professor of Health Economics at Oxford University.
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