Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Isr J Health Policy Res. 2021 Feb 19;10(1):14. doi: 10.1186/s13584-021-00452-2.
When attempting to provide lessons for other countries from the successful Israeli COVID-19 vaccine experience, it is important to distinguish between the modifiable and non-modifiable components identified in the article by Rosen, et al. Two specific modifiable components included in the Israeli program from which the US can learn are (a) a national (not individual state-based) strategy for vaccine distribution and administration and (b) a functioning public health infrastructure. As a federal government, the US maintains an often complex web of state and national authorities and responsibilities. The federal government assumed responsibility for the ordering, payment and procurement of COVID vaccine from manufacturers. In designing the subsequent steps in their COVID-19 vaccine distribution and administration plan, the Trump administration decided to rely on the states themselves to determine how best to implement guidance provided by the Centers for Disease Control and Prevention (CDC). This strategy resulted in 50 different plans and 50 different systems for the dissemination of vaccine doses, all at the level of each individual state. State health departments were neither financed, experienced nor uniformly possessed the expertise to develop and implement such plans. A national strategy for the distribution, and the workforce for the provision, of vaccine beyond the state level, similar to that which occurred in Israel, would have provided for greater efficiency and coordination across the country. The US public health infrastructure was ill-prepared and ill-staffed to take on the responsibility to deliver > 450 million doses of vaccine in an expeditious fashion, even if supply of vaccine was available. The failure to adequately invest in public health has been ubiquitous across the nation at all levels of government. Since the 2008 recession, state and local health departments have lost > 38,000 jobs and spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%. Hopefully, COVID-19 will be a wakeup call to the US with regard to the need for both a national strategy to address public health emergencies and the well-maintained infrastructure to make it happen.
当试图从以色列成功的 COVID-19 疫苗经验中为其他国家提供经验教训时，重要的是要区分罗森等人文章中确定的可修改和不可修改的部分。以色列计划中有两个具体的可修改部分，美国可以从中学习：(a) 疫苗分发和管理的国家（非个别州）战略，以及 (b) 运作良好的公共卫生基础设施。作为联邦政府，美国维持着一个经常是复杂的州和国家当局和责任网络。联邦政府负责从制造商那里订购、支付和采购 COVID 疫苗。在设计 COVID-19 疫苗分发和管理计划的后续步骤时，特朗普政府决定依靠各州本身来确定如何最好地实施疾病控制与预防中心 (CDC) 提供的指导。这一策略导致了 50 个不同的计划和 50 个不同的系统来分发疫苗剂量，所有这些都是在每个州的水平上进行的。州卫生部门既没有资金，也没有经验，也没有统一的专业知识来制定和实施此类计划。类似于以色列发生的情况，在州一级以外分配疫苗的国家战略和提供疫苗的劳动力将为全国提供更大的效率和协调。美国公共卫生基础设施准备不足，人员配备不足，无法迅速承担提供超过 4.5 亿剂疫苗的责任，即使疫苗供应可用。全国各地各级政府都普遍存在对公共卫生投资不足的问题。自 2008 年经济衰退以来，州和地方卫生部门已经失去了超过 38000 个工作岗位，州公共卫生部门的支出人均下降了 16%，地方卫生部门的支出下降了 18%。希望 COVID-19 能让美国意识到，需要制定国家战略来应对公共卫生紧急情况，并维护良好的基础设施来实现这一目标。
