Los webinars de los jueves SARS-CoV-2

Hospital Clínic de Barcelona

2ª
Edición

Dra Silvia de Sanjosé

Senior Consultant en
National Cancer Institute
(NCI) and at PATH
A QUIÉN DEBEMOS VACUNAR DEL SARS-COV-2
Hospital Clínic Barcelona

SIN CONFLICTO DE INTERESES

Organización Colaboración Patrocinadores SILVER

GCMSC
• The presentation is the product of ongoing work of the GCMSC (Grup
col.laboratiu multidiciplinar per el seguiment científic de la COVID-19) that
includes:
• Josep M Miro, Quique Bassat, Magda Campins, Robert Guerri, Carles
Brotons, Juana Diez, Julià Blanco, Mireia Sans, Olga Rubio, Adelaida
Sarukhan.
• Additional support from ISGlobal Toni Plasencia and Josep M Anto

• The group has been promoted by ISGlobal, the College of Medical doctors of
Barcelona , with the col.laboration of the Catalan Association of Research
Centres (ACER) and had its first meeting on September 3rd 2020.
Who will need a • Any person for whom the vaccine is
vaccine? indicated, if the vaccine is proven to
be efficacious and safe
 • Reduce mortality
Why do we need a • Reduce severe morbidity
SARS-CoV-2 • Reduce the negative societal impact
vaccine? • Reduce incidence of infection
 • Limited vaccine doses in early phases

• How to distribute first vaccines following

The problem ethical and programmatic criteria

• Need to think in phases until vaccine is

available for all
The vaccines
 ‘The first generation of vaccines is likely
to be imperfect, and we should be
prepared that they might not prevent
The first infection but rather reduce symptoms,
vaccines and, even then, might not work for
everyone or for long.’ K Bingham

K Bingham UK Government's Vaccine Taskforce, Lancet 2020

The first Covid vaccines may vary across critical aspects

Duration of
Efficacy protection

Effect
modifiers:
Safety
Age, delivery
mode, …
 Age as a potential effect modifier of the
vaccine efficacy… need to see Phase 3 results.
Modeling the impact in mortality

The impact of a given vaccine in reducing mortality shows a major impact among those age 60+,
Under an age depending reduction of efficacy, benefits in the reduction of mortality among 60+ gets closer
to that observed among 20-49.
Bubar et al. 2020
The people
 The most
vulnerable
The most
(morbidity
exposed
and
mortality)
How to prioritize?

Those most
needed High
(societal spreaders
impact)

US National Academy of Sciences, 2020

 Fundamental ethical principles

The greatest Benefit to the Greatest number of individuals while the Fewest resources
are used

• Allocating resources to those most likely to survive.

• For people with similar likelihood of benefit, resources should
be allocated to those with the greatest urgent or acute need.
• Maximize opportunities to help more people.
• People who perform vital functions (e.g., health care workers,
first responders)
• When all other factors are equal, randomize.

Laventhal et al., 2020

 WHO Working Group on Ethics and COVID-19
• Vaccine prioritization:
• People at greatest risk of becoming infected and seriously ill
• People who would prevent the greatest spread of the virus if vaccinated
• People who have volunteered to participate in research to develop the
vaccine.
The principle of global equity holds that
• (1) the priority groups identified by the WHO SAGE values framework should inform global-level
allocation
decisions and
• (2) countries with greater financial resources should not undermine vaccine access for low- and
middle- income countries.

WHO, 2020
 COVID-19 related death in the UK
by age and gender

(EJ Williamson Nature 2020 using OpenSafely)

COVID-19 risk factors linked to death, UK
Age

(EJ Williamson Nature 2020 using OpenSafely)

Sex

Obesity

Diabetes, uncontrolled
COVID-19 risk factors linked to death, UK
Cancer

(EJ Williamson Nature 2020 using OpenSafely)

Hematological malignancy

CKF

COPD

Other comorbidities
Agencies and Societies are in general agreement in establishing priorities
P1-P3 refer to Phases of vaccine introduction Royal Society in UK National Academy of WHO ACIP
Medicine US

Health workers in close contact P1 P1a P1 P1

First responders P1 P1a P1 P1

Age P1 P1b P1 P1

Lottery allocation when numbers outweigh resources for equal risk

Elderly 65+ living in Lottery Elderly
congregate settings allocation
P2 P2
Other elderly 65+ >65 years old
Morbidity (Diabetes, ICD, COPD, Obesity,..) P1 P1 P2
High risk P1b Lottery
P2 allocation
Moderate risk
Specific essential occupations P2 P2 P2
Teachers and occupations Teachers K-12 & staff, Essential
at high risk of exposure critical industry workers workers

Underprivileged groups P2
Homeless,
institutionalized & staff
 Summary from the GCMSC (work in progress)
SMALL  Health workers in contact with patients including
QUANTITY
nursing homes and first responders
 Elderly above age 80+, 65+
 Morbid conditions like diabetes mellitus, ischemic
heart disease history, CODP, morbid obesity, cancer
patients under chemotherapy, immunosuppression
<200 CD4 cell counts
 Essential workers
 Older than 55+
 Vaccines for all
45+M
GCMSC Grup col.laboratiu multidiciplinar per el seguiment científic de la COVID-19
 Numbers
Potential priority groups Phase 1-2 Spain
Health workers if in contact with patients 513.777
First responders and essential workers 1.7/7.5M
Older than 64 (19%) 9M
Older than 64 and diabetes (21%) 2M
Diabetes 6.5 M
Incarcerated 59.589
TOTAL POPULATION 47.3M

Numbers are approximate based on routine statistics and reports

 Withhold a percentage?
• To withhold a percentage (e.g., 10 percent) of
available vaccine supply as a reserve for use in
areas of special need or epidemiological “hot
spots”.

US National Academy of Sciences, 2020

 Additional relevant aspects
 Keep on using masks, hands washing and social distance until there is a
population sustained immunity
 A Communication plan to the general population, assuming that there may
be a certain resistance and anti/vaccine movements.
 The general public need to understand the benefits and risks of the
proposed vaccine or vaccines and why there is prioritization1.
 A surveillance plan to oversee the coverage, acceptability and side effects
of the vaccines with a fast process to be able to provide an immediate
response if any relevant AE is detected. A plan for disruptions and how to
respond should be in place before initiation of the vaccination process.

(1) Lazarus et al Nature Med. 71.5% of the people likely to take the vaccine
Thank you for your attention
 Los webinars de los jueves SARS-CoV-2
Hospital Clínic de Barcelona

Muchas 2ª
Edición
gracias por
su atención

Dra Silvia de Sanjosé

Senior Consultant en National Cancer Institute (NCI) and at PATH
Hospital Clínic Barcelona
sdesanjose@path.org

Organización Colaboración Patrocinadores SILVER