全球首例 COVID-19 疫苗接种一年的影响：一项数学建模研究。

Global impact of the first year of COVID-19 vaccination: a mathematical modelling study.

机构信息

MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.

出版信息

Lancet Infect Dis. 2022 Sep;22(9):1293-1302. doi: 10.1016/S1473-3099(22)00320-6. Epub 2022 Jun 23.

DOI:10.1016/S1473-3099(22)00320-6

PMID:35753318

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9225255/

Abstract

BACKGROUND: The first COVID-19 vaccine outside a clinical trial setting was administered on Dec 8, 2020. To ensure global vaccine equity, vaccine targets were set by the COVID-19 Vaccines Global Access (COVAX) Facility and WHO. However, due to vaccine shortfalls, these targets were not achieved by the end of 2021. We aimed to quantify the global impact of the first year of COVID-19 vaccination programmes. METHODS: A mathematical model of COVID-19 transmission and vaccination was separately fit to reported COVID-19 mortality and all-cause excess mortality in 185 countries and territories. The impact of COVID-19 vaccination programmes was determined by estimating the additional lives lost if no vaccines had been distributed. We also estimated the additional deaths that would have been averted had the vaccination coverage targets of 20% set by COVAX and 40% set by WHO been achieved by the end of 2021. FINDINGS: Based on official reported COVID-19 deaths, we estimated that vaccinations prevented 14·4 million (95% credible interval [Crl] 13·7-15·9) deaths from COVID-19 in 185 countries and territories between Dec 8, 2020, and Dec 8, 2021. This estimate rose to 19·8 million (95% Crl 19·1-20·4) deaths from COVID-19 averted when we used excess deaths as an estimate of the true extent of the pandemic, representing a global reduction of 63% in total deaths (19·8 million of 31·4 million) during the first year of COVID-19 vaccination. In COVAX Advance Market Commitment countries, we estimated that 41% of excess mortality (7·4 million [95% Crl 6·8-7·7] of 17·9 million deaths) was averted. In low-income countries, we estimated that an additional 45% (95% CrI 42-49) of deaths could have been averted had the 20% vaccination coverage target set by COVAX been met by each country, and that an additional 111% (105-118) of deaths could have been averted had the 40% target set by WHO been met by each country by the end of 2021. INTERPRETATION: COVID-19 vaccination has substantially altered the course of the pandemic, saving tens of millions of lives globally. However, inadequate access to vaccines in low-income countries has limited the impact in these settings, reinforcing the need for global vaccine equity and coverage. FUNDING: Schmidt Science Fellowship in partnership with the Rhodes Trust; WHO; UK Medical Research Council; Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation; National Institute for Health Research; and Community Jameel.

摘要

背景：2020 年 12 月 8 日，在临床试验之外，首次接种了新冠疫苗。为确保全球疫苗公平分配，新冠疫苗全球获取机制（COVAX）和世界卫生组织（WHO）设定了疫苗接种目标。然而，由于疫苗短缺，到 2021 年底，这些目标并未实现。我们旨在量化新冠疫苗接种计划实施第一年的全球影响。

方法：我们分别使用报告的 COVID-19 死亡率和 185 个国家和地区的所有原因超额死亡率数据，对 COVID-19 传播和疫苗接种的数学模型进行拟合。通过估计如果没有分发疫苗，将会有多少人丧生，来确定 COVID-19 疫苗接种计划的影响。我们还估计了如果 COVAX 设定的 20%接种覆盖率和 WHO 设定的 40%接种覆盖率在 2021 年底前实现，将会避免多少额外死亡。

结果：根据官方报告的 COVID-19 死亡人数，我们估计，2020 年 12 月 8 日至 2021 年 12 月 8 日期间，在 185 个国家和地区，疫苗接种预防了 1440 万人（95%可信区间[Crl] 1370-1590）死于 COVID-19。当我们将超额死亡作为大流行真实范围的估计值时，这一估计值上升至 1980 万人（95% Crl 1910-2040）避免死于 COVID-19，这代表在 COVID-19 疫苗接种的第一年，全球总死亡人数减少了 63%（3140 万人中的 1980 万人）。在 COVAX 预付款采购机制国家，我们估计，41%（740 万人[95% Crl 680-770]的 1790 万人死亡）的超额死亡率得到了避免。在低收入国家，我们估计，如果 COVAX 设定的 20%的接种覆盖率目标能够在每个国家实现，那么还可以额外避免 45%（95% CrI 42-49）的死亡，如果到 2021 年底，每个国家都能实现 WHO 设定的 40%的目标，那么还可以额外避免 111%（105-118）的死亡。

解释：COVID-19 疫苗接种极大地改变了大流行的进程，在全球范围内挽救了数以千万计的生命。然而，低收入国家获得疫苗的机会不足，限制了这些地区的影响，这再次强调了全球疫苗公平分配和覆盖的必要性。

资助：施密特科学奖学金，与罗兹信托基金会合作；世卫组织；英国医学研究理事会；全球疫苗免疫联盟；比尔及梅琳达·盖茨基金会；英国国家卫生研究院；社区贾米尔。