Schaefer G Owen, Emanuel Ezekiel J, Atuire Caesar A, Leland R J, Persad Govind, Richardson Henry S, Saenz Carla
Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Vaccine. 2023 Nov 22;41(48):7084-7088. doi: 10.1016/j.vaccine.2023.07.021. Epub 2023 Jul 16.
With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm.
随着全球努力应对猴痘在国际上的持续传播，疫苗在减轻感染危害和防止传播方面发挥着关键作用。然而，最需要疫苗的国家——特别是猴痘病死率最高的历史流行国家——却无法获得稀缺的疫苗。这是不公平的，需要通过在全球公平分配疫苗来加以纠正。我们建议在这种分配中应用公平优先模型，该模型强调三个关键原则：1）预防危害；2）优先考虑弱势群体；3）给予人们同等的道德关怀。暴露后预防（PEPV）在减轻危害方面潜力最大，因此确保各国拥有足够的暴露后预防疫苗供应应作为首要优先事项。而历史流行国家面临着使猴痘潜在危害加剧的不利因素，应成为此类疫苗的首批接受者。一旦为各国分配了足够的暴露后预防疫苗供应，全球分配可以转向暴露前预防（PrEP），同样基于预计病例数和易受危害程度，在分配给全球其他地区之前，再次优先考虑历史流行国家。
