¿Quién debería recibir primero la vacuna contra el coronavirus?

Un equipo internacional de investigadores muestra un nuevo modelo para suministrar la potencial vacuna frente a la covid-19 que priorizaría la reducción de las muertes prematuras
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One of the greatest achievements in public health will be to achieve an effective vaccine against covid-19. However, it is feared for its supply, predictably scarce. In fact, healthcare institutions, world leaders and pharmaceutical companies are already faced with the challenge of appropriately allocating them between countries. But is it possible to make a fair and equitable distribution in practice with theplanettoday?

Public health experts from around the world have proposed a new three-phase plan for vaccine distribution, called the ‘Fair Priority Model’, which aims to reduce premature deaths and other irreversible consequences of the disease. The findings are published this week in Science.

At the moment there is no single global distribution framework for doses, although there are two main proposals. On the one hand, that health workers and high-risk populations, such as those over 65, should be immunized first; and on the other, the World Health Organization (WHO) suggests that countries receive doses proportional to their populations.

This new model identifies three values ​​when distributing a vaccine: benefit people and limit harm, prioritize the disadvantaged, and provide the same moral concern to all individuals

Both strategies are seriously flawed, according to the study led by Ezekiel J. Emanuel, Vice Chancellor for Global Initiatives and President of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania (USA).

«The idea of ​​distributing vaccines by population seems to be an equitable strategy, but it erroneously assumes that equality requires treating countries located in different places identically,» Emanuel explains to Sinc. “This is the first systematic ethical analysis of how to distribute scarce medical resources among countries. Ethics have always been seen as a minor but increasingly important part ”.

In their new model, the authors point out three core values ​​that must be considered when distributing a COVID-19 vaccine: benefit people and limit harm, prioritize the disadvantaged, and provide the same moral concern for all individuals. The aim is to address these values ​​by focusing on the mitigation of three types of damage caused by the new coronavirus: death and permanent damage to organs, indirect consequences for health – such as tension and stress in the health system – as well as like the economic crisis.

«However, right now the prevention of deaths – especially premature ones – is particularly urgent,» the authors insist. In future phases, they propose two measures that capture general economic improvement and how to get out of poverty. “Our model will change which countries receive the vaccine and in what order. It should first go to the places where the vaccine can reduce the most premature deaths and then alleviate the greatest economic devastation, ”says Emanuel.

And after that, give initial priority to the countries with the highest transmission rates. «All countries should receive enough vaccines to stop transmission, which requires that between 60 and 70% of the population be immune,» he points out.

A fair and equitable distribution

El plan de la OMS, por el contrario, comienza con el 3 % de la población de cada país recibiendo vacunas, y continúa con la asignación proporcional a la población hasta que cada país haya vacunado al 20 % de sus ciudadanos.

Si bien ese plan puede ser políticamente defendible, “trata de forma idéntica a países de distinta situación, en lugar de responder equitativamente a sus diferentes necesidades. Los países igualmente poblados se enfrentan a niveles dramáticamente diferentes de muerte y devastación económica por la pandemia”, indica el nuevo estudio.

Los autores se oponen a dar prioridad a los países en función del número de trabajadores sanitarios, la población mayor de 65 años y el número de personas con comorbilidades

Los autores también se oponen a un plan que daría prioridad a los países en función del número de trabajadores sanitarios de primera línea, la proporción de población mayor de 65 años y el número de personas con comorbilidades.

“Inmunizar preferentemente a los trabajadores de la salud –que ya tienen acceso a equipos de protección personal y otros métodos avanzados de prevención de enfermedades infecciosas– probablemente no reduciría sustancialmente el daño en los países de mayores ingresos”, añaden.

Del mismo modo, centrarse en vacunar a los países con poblaciones de mayor edad no reduciría necesariamente la propagación del virus o minimizaría la muerte. Además, los países de ingresos bajos y medios tienen menos residentes de edad avanzada y trabajadores de la salud per cápita que los estados más enriquecidos.

«This would end up administering many vaccines to rich countries, which is not the goal of a fair and equitable distribution,» says Emanuel. “Those responsible are looking for a framework to ensure global vaccination, so that we can stop the spread of this virus. It will be up to the political leaders, the WHO and the manufacturers to implement our model ”, he concludes.

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