從美國(guó)開(kāi)始接種新冠肺炎疫苗至今已經(jīng)兩個(gè)多月了,在這個(gè)混亂的過(guò)程中,始終存在一個(gè)核心爭(zhēng)議:誰(shuí)應(yīng)該第一批接種疫苗?老年人、醫(yī)療上的弱勢(shì)群體、必要崗位工作人員或者是任何一個(gè)真正愿意打這玩意兒的人?人們一直在這幾個(gè)答案間來(lái)來(lái)回回?,F(xiàn)在,隨著強(qiáng)生公司(Johnson & Johnson)的疫苗有望上市,討論又增加了一個(gè)維度:誰(shuí)應(yīng)該接種哪種疫苗?
強(qiáng)生公司的疫苗尚未獲得美國(guó)食品和藥物管理局的批準(zhǔn),但一旦獲批用于緊急使用,明年3月就能開(kāi)始出貨。從臨床試驗(yàn)的結(jié)果來(lái)看,強(qiáng)生的疫苗表面上與已獲批準(zhǔn)的莫德納(Moderna)和輝瑞(Pfizer)疫苗有顯著不同。
強(qiáng)生的疫苗似乎更方便:可以儲(chǔ)存在普通的冰箱里,只需接種一針即可;莫德納和輝瑞的疫苗必須儲(chǔ)存在可保證零下70攝氏度的專用冰柜中,需注射兩劑,中間間隔數(shù)周。但莫德納和輝瑞的疫苗似乎更有效:他們的疫苗預(yù)防中重癥的有效性約為95%;強(qiáng)生疫苗在美國(guó)的試驗(yàn)中,中重癥防護(hù)效果為72%,在南非僅為57%(在南非,一種高傳染性的新冠病毒變種導(dǎo)致病例激增)。
需要注意的是,流行病學(xué)家仍然認(rèn)為72%的結(jié)果相當(dāng)好,而且在強(qiáng)生公司的試驗(yàn)中,沒(méi)有出現(xiàn)一起死亡病例。話雖如此,考慮到美國(guó)存在系統(tǒng)性的醫(yī)療歧視問(wèn)題,不難想象某些社區(qū)會(huì)因?yàn)橹坏玫健拜^弱”的疫苗而憤憤不平。
新冠肺炎對(duì)有色人種的影響尤為嚴(yán)重。據(jù)《大西洋月刊》(Atlantic)的新冠肺炎追蹤項(xiàng)目統(tǒng)計(jì),全美范圍內(nèi),黑人的死亡率是白人的1.5倍,在美國(guó)迄今45.6萬(wàn)例新冠死亡病例中占大約6.4萬(wàn)例。原住民和西班牙裔的死亡率也高于美國(guó)白人。
有幾方面的原因,其中包括在必要崗位工作者中,少數(shù)族裔美國(guó)人的占比過(guò)高,因此暴露在病毒中的風(fēng)險(xiǎn)也更高。此外,就非裔美國(guó)人而言,他們的疫苗接種率也遠(yuǎn)低于白人。本周早些時(shí)候,美國(guó)疾病控制與預(yù)防中心發(fā)布了一份報(bào)告,在接種過(guò)疫苗的美國(guó)人中,大約僅有5.4%是黑人,而黑人在美國(guó)人口中占比為13%。非西班牙裔美國(guó)白人的接種人數(shù)按照其在總?cè)丝谥械恼急确€(wěn)步上升。
這種不平等很大程度上歸結(jié)于缺乏醫(yī)療資源,以及對(duì)聯(lián)邦政府醫(yī)療系統(tǒng)的不信任。
“要想消除這些障礙,無(wú)論是溝通上還是操作上都很艱?!眲P薩家庭基金會(huì)(Kaiser Family Foundation)負(fù)責(zé)全球衛(wèi)生政策的副主任喬希·米肖德說(shuō),“對(duì)新疫苗及其將如何適應(yīng)總體疫苗戰(zhàn)略的擔(dān)憂是不無(wú)道理的。我們手頭每一種疫苗的優(yōu)劣都截然不同,強(qiáng)生公司的產(chǎn)品更是如此?!?/p>
米肖德說(shuō),溝通的關(guān)鍵在于要摒棄任何“低級(jí)”或“高級(jí)”疫苗的概念。在降低住院率上,強(qiáng)生公司疫苗的防護(hù)效果也非??捎^,可以保護(hù)人們免于新冠肺炎重癥,從而為患有其他嚴(yán)重疾病的患者騰出床位。而且,接種強(qiáng)生疫苗的人中沒(méi)有一人死亡。
“如果我們關(guān)注的是減少住院和死亡人數(shù),無(wú)論能拿到哪種疫苗,接種就行?!眴讨稳A盛頓大學(xué)(George Washington University)健康管理和政策教授杰弗里·利瓦伊說(shuō),“你接種的疫苗就是最好的疫苗。”
利瓦伊說(shuō),強(qiáng)生公司疫苗單次注射而且可以使用普通冰箱儲(chǔ)存的優(yōu)勢(shì),可以造福交通不便的農(nóng)村地區(qū)和沒(méi)有大功率冰柜的社區(qū)。
“這樣兩相抵消就平衡了?!彼f(shuō),“只需一次注射的便利有利于更多人得到疫苗。目前最重要的公平問(wèn)題是供應(yīng)問(wèn)題。我們需要為更多的人提供更多疫苗。但感覺(jué)我們似乎無(wú)法滿足這么人的接種需求,因此任何可以提高疫苗供應(yīng)的措施都會(huì)有所幫助?!?/p>
不可避免的是,尤其是一開(kāi)始,有些社區(qū)或許只有一種疫苗選擇。但公共衛(wèi)生專家說(shuō),總的來(lái)說(shuō),隨著疫苗接種計(jì)劃不斷改善,強(qiáng)生公司的疫苗(如果獲批用于緊急使用)以及其他新疫苗(如阿斯利康公司和牛津大學(xué)共同研發(fā)的疫苗)應(yīng)該可以多管齊下,為盡可能多的人接種。像強(qiáng)生這樣的單針疫苗可能被用于臨時(shí)大規(guī)模疫苗接種診所。莫德納和輝瑞等其他有效性更強(qiáng)的疫苗可能會(huì)優(yōu)先用于醫(yī)療上特別脆弱的人群?!靶枰ㄟ^(guò)多種形式共同接種,”利瓦伊說(shuō)。
“如果有人給我提供強(qiáng)生公司的疫苗,我會(huì)毫不猶豫地接受。”米肖德說(shuō),“這才是我們想傳達(dá)給公眾的信息。并不是把劣質(zhì)產(chǎn)品分給某些人,把優(yōu)質(zhì)產(chǎn)品分給另外一些人。我們必須積極駁斥這種觀點(diǎn)?!保ㄘ?cái)富中文網(wǎng))
譯者:Agatha
從美國(guó)開(kāi)始接種新冠肺炎疫苗至今已經(jīng)兩個(gè)多月了,在這個(gè)混亂的過(guò)程中,始終存在一個(gè)核心爭(zhēng)議:誰(shuí)應(yīng)該第一批接種疫苗?老年人、醫(yī)療上的弱勢(shì)群體、必要崗位工作人員或者是任何一個(gè)真正愿意打這玩意兒的人?人們一直在這幾個(gè)答案間來(lái)來(lái)回回?,F(xiàn)在,隨著強(qiáng)生公司(Johnson & Johnson)的疫苗有望上市,討論又增加了一個(gè)維度:誰(shuí)應(yīng)該接種哪種疫苗?
強(qiáng)生公司的疫苗尚未獲得美國(guó)食品和藥物管理局的批準(zhǔn),但一旦獲批用于緊急使用,明年3月就能開(kāi)始出貨。從臨床試驗(yàn)的結(jié)果來(lái)看,強(qiáng)生的疫苗表面上與已獲批準(zhǔn)的莫德納(Moderna)和輝瑞(Pfizer)疫苗有顯著不同。
強(qiáng)生的疫苗似乎更方便:可以儲(chǔ)存在普通的冰箱里,只需接種一針即可;莫德納和輝瑞的疫苗必須儲(chǔ)存在可保證零下70攝氏度的專用冰柜中,需注射兩劑,中間間隔數(shù)周。但莫德納和輝瑞的疫苗似乎更有效:他們的疫苗預(yù)防中重癥的有效性約為95%;強(qiáng)生疫苗在美國(guó)的試驗(yàn)中,中重癥防護(hù)效果為72%,在南非僅為57%(在南非,一種高傳染性的新冠病毒變種導(dǎo)致病例激增)。
需要注意的是,流行病學(xué)家仍然認(rèn)為72%的結(jié)果相當(dāng)好,而且在強(qiáng)生公司的試驗(yàn)中,沒(méi)有出現(xiàn)一起死亡病例。話雖如此,考慮到美國(guó)存在系統(tǒng)性的醫(yī)療歧視問(wèn)題,不難想象某些社區(qū)會(huì)因?yàn)橹坏玫健拜^弱”的疫苗而憤憤不平。
新冠肺炎對(duì)有色人種的影響尤為嚴(yán)重。據(jù)《大西洋月刊》(Atlantic)的新冠肺炎追蹤項(xiàng)目統(tǒng)計(jì),全美范圍內(nèi),黑人的死亡率是白人的1.5倍,在美國(guó)迄今45.6萬(wàn)例新冠死亡病例中占大約6.4萬(wàn)例。原住民和西班牙裔的死亡率也高于美國(guó)白人。
有幾方面的原因,其中包括在必要崗位工作者中,少數(shù)族裔美國(guó)人的占比過(guò)高,因此暴露在病毒中的風(fēng)險(xiǎn)也更高。此外,就非裔美國(guó)人而言,他們的疫苗接種率也遠(yuǎn)低于白人。本周早些時(shí)候,美國(guó)疾病控制與預(yù)防中心發(fā)布了一份報(bào)告,在接種過(guò)疫苗的美國(guó)人中,大約僅有5.4%是黑人,而黑人在美國(guó)人口中占比為13%。非西班牙裔美國(guó)白人的接種人數(shù)按照其在總?cè)丝谥械恼急确€(wěn)步上升。
這種不平等很大程度上歸結(jié)于缺乏醫(yī)療資源,以及對(duì)聯(lián)邦政府醫(yī)療系統(tǒng)的不信任。
“要想消除這些障礙,無(wú)論是溝通上還是操作上都很艱?!眲P薩家庭基金會(huì)(Kaiser Family Foundation)負(fù)責(zé)全球衛(wèi)生政策的副主任喬希·米肖德說(shuō),“對(duì)新疫苗及其將如何適應(yīng)總體疫苗戰(zhàn)略的擔(dān)憂是不無(wú)道理的。我們手頭每一種疫苗的優(yōu)劣都截然不同,強(qiáng)生公司的產(chǎn)品更是如此?!?/p>
米肖德說(shuō),溝通的關(guān)鍵在于要摒棄任何“低級(jí)”或“高級(jí)”疫苗的概念。在降低住院率上,強(qiáng)生公司疫苗的防護(hù)效果也非??捎^,可以保護(hù)人們免于新冠肺炎重癥,從而為患有其他嚴(yán)重疾病的患者騰出床位。而且,接種強(qiáng)生疫苗的人中沒(méi)有一人死亡。
“如果我們關(guān)注的是減少住院和死亡人數(shù),無(wú)論能拿到哪種疫苗,接種就行?!眴讨稳A盛頓大學(xué)(George Washington University)健康管理和政策教授杰弗里·利瓦伊說(shuō),“你接種的疫苗就是最好的疫苗?!?/p>
利瓦伊說(shuō),強(qiáng)生公司疫苗單次注射而且可以使用普通冰箱儲(chǔ)存的優(yōu)勢(shì),可以造福交通不便的農(nóng)村地區(qū)和沒(méi)有大功率冰柜的社區(qū)。
“這樣兩相抵消就平衡了?!彼f(shuō),“只需一次注射的便利有利于更多人得到疫苗。目前最重要的公平問(wèn)題是供應(yīng)問(wèn)題。我們需要為更多的人提供更多疫苗。但感覺(jué)我們似乎無(wú)法滿足這么人的接種需求,因此任何可以提高疫苗供應(yīng)的措施都會(huì)有所幫助。”
不可避免的是,尤其是一開(kāi)始,有些社區(qū)或許只有一種疫苗選擇。但公共衛(wèi)生專家說(shuō),總的來(lái)說(shuō),隨著疫苗接種計(jì)劃不斷改善,強(qiáng)生公司的疫苗(如果獲批用于緊急使用)以及其他新疫苗(如阿斯利康公司和牛津大學(xué)共同研發(fā)的疫苗)應(yīng)該可以多管齊下,為盡可能多的人接種。像強(qiáng)生這樣的單針疫苗可能被用于臨時(shí)大規(guī)模疫苗接種診所。莫德納和輝瑞等其他有效性更強(qiáng)的疫苗可能會(huì)優(yōu)先用于醫(yī)療上特別脆弱的人群?!靶枰ㄟ^(guò)多種形式共同接種,”利瓦伊說(shuō)。
“如果有人給我提供強(qiáng)生公司的疫苗,我會(huì)毫不猶豫地接受。”米肖德說(shuō),“這才是我們想傳達(dá)給公眾的信息。并不是把劣質(zhì)產(chǎn)品分給某些人,把優(yōu)質(zhì)產(chǎn)品分給另外一些人。我們必須積極駁斥這種觀點(diǎn)?!保ㄘ?cái)富中文網(wǎng))
譯者: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.”