Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
Inner City Health, Metro City Medical Clinic, Edmonton, Alberta, Canada.
BMJ Glob Health. 2021 Jan;6(1). doi: 10.1136/bmjgh-2020-004087.
The COVID-19 pandemic has exposed social inequities that rival biological inequities in disease exposure and severity. Merely identifying some inequities without understanding all of them can lead to harmful misrepresentations and deepening disparities. Applying an 'equity lens' to bring inequities into focus without a vision to extinguish them is short-sighted. Interventions to address inequities should be as diverse as the pluralistic populations experiencing them. We present the first validated equity framework applied to COVID-19 that sheds light on the full spectrum of health inequities, navigates their sources and intersections, and directs ethically just interventions. The Equity Matrix also provides a comprehensive map to guide surveillance and research in order to unveil epidemiological uncertainties of novel diseases like COVID-19, recognising that inequities may exist where evidence is currently insufficient. Successfully applied to vaccines in recent years, this tool has resulted in the development of clear, timely and transparent guidance with positive stakeholder feedback on its comprehensiveness, relevance and appropriateness. Informed by evidence and experience from other vaccine-preventable diseases, this Equity Matrix could be valuable to countries across the social gradient to slow the spread of SARS-CoV-2 by abating the spread of inequities. In the race to SARS-CoV-2 vaccines, this urgently needed roadmap can effectively and efficiently steer global leadership towards equitable allocation with diverse strategies for diverse inequities. Such a roadmap has been absent from discussions on managing the COVID-19 pandemic, and is critical for our passage out of it.
新冠疫情暴露了社会不平等现象，这些不平等现象在疾病暴露和严重程度方面可与生物不平等现象相媲美。仅仅确定一些不平等现象而不了解所有这些不平等现象，可能会导致有害的误解和差距的加深。应用“公平视角”来关注不平等现象，而没有消除这些不平等现象的愿景，是目光短浅的。解决不平等问题的干预措施应该与经历这些不平等问题的多元化人群一样多样化。我们提出了第一个应用于 COVID-19 的经过验证的公平框架，该框架揭示了健康不平等的全貌，探讨了其来源和交叉点，并指导了符合道德规范的公平干预措施。公平矩阵还提供了一张全面的地图，以指导监测和研究，以揭示像 COVID-19 这样的新型疾病的流行病学不确定性，认识到在证据目前不足的地方可能存在不平等现象。近年来，该工具在疫苗方面的成功应用，导致了明确、及时和透明的指导意见的制定，并得到了利益相关者对其全面性、相关性和适当性的积极反馈。根据其他可预防疫苗疾病的证据和经验，这个公平矩阵可以为社会梯度不同的国家提供宝贵的参考，通过减轻不平等现象的传播来减缓 SARS-CoV-2 的传播。在 SARS-CoV-2 疫苗竞赛中，这个急需的路线图可以有效地和有效地引导全球领导层采取公平的分配方式，并为不同的不平等现象制定多样化的策略。在管理 COVID-19 大流行的讨论中，这种路线图一直缺失，对于我们走出这场大流行至关重要。
