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Additional Workgroup
Considerations in COVID-19
Vaccination Policy and Practice
Evolution of a vaccine program. Chen RT, Orenstein WA. Epidemiologic methods in immunization programs. Epidemiol Rev.
1996;18(2):102. Copyright © 1996 by the Oxford University Press.
Edwards K, Hackell J, Committee on Infectious Diseases, Committee on Practice and Ambulatory Medicine
Pediatrics Sep 2016, 138 (3) e20162146; DOI: 10.1542/peds.2016- 2146Simple, stable recommendations
can increase vaccine coverage
VAERS does not identify causality; rather it is a signal detection tool
•Vaccination provided additional protection against COVID -19-associated:
ER and UC visits among children; protection generally similar across
age groups
ER and UC visits and hospitalizations compared to no vaccine dose
among adults
critical illness among older adults; protection appeared to be more
durable against critical illness compared to less severe outcomes
•VE should be interpreted as the added benefit of COVID -19 vaccination in
a population with high levels of infection- induced immunity, vaccine-
induced immunity, or both Effectiveness of COVID -19 vaccination
EthicsScience
ImplementationThree Pillars of the ACIP:
Science and Much More
Lee G, Bell B, Romero J. The Advisory Committee on Immunization Practices and
Its Role in the Pandemic Vaccine Response. JAMA Published Online J uly 22,
2020. doi:10.1001/jama.2020.13167
•Healthcare providers always discuss vaccination pros/cons with patients.
•In principle, clear recommendations and SCDM reach the same goal.
•With routine, age - or risk -based recommendations, the default
decision is to vaccinate all patients that consent
•However, recommendations with SCDM are perceived differently.
SCDM has no default – vaccination is often interpreted as optional
•Plus, the need for a provider prescription creates an unnecessary step to
receiving a vaccine and does not effectively target those at high riskShared clinical decision -making (SCDM)
and a need for provider prescription
create barriers to COVID -19 vaccination
25%
17% 18%39%2023 CHILD POPULATION BY AGE GROUP IN US
(CHILDREN < 5 MORE LIKELY TO BE INFECTION NAÏVE)
Data from the U.S. Census Bureau, Population Division
Annie E. Casey Foundation tracks the well -being of children, youth, and families in US
< 6 months
6-23 months
Antepartum Vaccination Protects
Newborns and Young Infants
“Immunosenescence” means older
people do not have as good an
immune response as when younger
Key Messages for Consideration
•The ACIP pillars are not driven by science alone; implementation
and ethics are additional important considerations for vaccine accessibility
•Simple, stable recommendations can increase vaccine coverage
•COVID -19 vaccines are highly safe and effective
•Shared clinical decision -making and the need for a provider
prescription create unnecessary steps to receiving a vaccine
and do not effectively target those at high risk
Key Messages for Consideration
•COVID -19 vaccination rates in the younger pediatric population
are very low: the primary COVID -19 vaccination series is needed
•Antepartum vaccination especially helps protect infection -naïve
newborns and young infants under 6 months of age
•Older people do not make as good an immune response as
when younger (“ Immunosenescence”)
•COVID -19 vaccination matters for pregnant women, pediatric
patients especially < 2 years of age, people 65 years and older, those of any age with a weakened immune system or chronic medical conditions, and anyone who feels they want
protection for themselves or their family !