An editorial in The Lancet dated December 4, 2020 looks at this important issue.

There are now several COVID-19 vaccine candidates that seem to be at least 90% efficacious. This was clearly received with much enthusiasm and unquestionable relief.

There is a challenge ahead in how this is going to be distributed when demand will far exceed the initial supply. As a result of this, nations and organisations will have to select which groups will have priority.

Age tiered approaches that also prioritise health and social care workers with certain reduced mortality and alleviate the pressure on health systems but this will leave vulnerable groups at risk.

Current evidence suggests that adults of any age with certain underlying health conditions including diabetes are at an increased risk of severe COVID-19.

In the United Kingdom according to a revised ranking issued in November 2020, all adults who are clinically extremely vulnerable such as those with specific cancers, severe respiratory conditions, and recipients of solid organ transplants have been placed in the same priority group as people aged 70 to 74 result.

All high risk adults younger than 65 and those with type 1 diabetes, type 2 diabetes and severe obesity with a BMI greater than 40 were placed in the priority 2 with the 60 to 64 age group.

Vaccination priority however, initially has not been universally agreed and may or may not be subject to public consultation in various countries.

Nations will face different challenges in vaccine allocation depending on various economic, political, social and epidemiological factors.

Vaccine planning will change with enhanced knowledge of both virus and vaccines. For example, data on sero-conversion and sero-protection for patients with COVID-19 are scarce since in many phase one and two trials, these groups were excluded due to safety considerations.

For the vaccine candidates with efficacy data announced so far, no data for patients with chronic health conditions have been disclosed to date.

Clearly, there are excellent reasons to be optimistic about new COVID-19 vaccine candidates, but it is essential that comorbidity data be disclosed as soon as available needs to inform vaccine planning. This is owed by the most clinical vulnerable patients in the community.

Dr Paul Ettlinger
The London General Practice

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