With input from Dr Monica Vasudev

1127: No-Fault Compensation for Vaccine Injury — What is the Other Side of Equitable Access to COVID-19 Vaccines?

1. The global vaccine race has over 200 vaccine candidates in preclinical and clinical development, with 11 in phase 3 trials.
2. Affluent governments that have invested in vaccine candidates have made bilateral agreements with developerswhich could lead to vaccine doses being reserved for the highest-income countries (Vaccine nationalism). This led to creation of the COVAX Facility, an international partnership to financially support leading vaccine candidates and ensure that lower-income countries have access to vaccines.  Seventy-nine higher-income countries are members of COVAX. Their governments will support 92 countries that would otherwise be unable to afford COVID-19 vaccines.
3. Now the question is protecting companies against the liability should COVID-19 vaccines cause real or perceived injuries to recipients.  Manufacturers may not agree to ship vaccine in the absence of liability protection.  In 2006, the International Federation of Pharmaceutical Manufacturers and Associations, had asked that manufacturers be granted protection from lawsuits associated with vaccine-related adverse events if they were participating in pandemic responses.
4. For a vaccine, there is an imminent risk of serious adverse events, such as seizures and allergic reactions, even in case of a very safe product.  Such events might not be known until a significant number of people have received the vaccination.
5. The dilemma for low- and middle-income countries is whether to refuse manufacturers protection against liability and proceed without COVID-19 vaccines or to offer liability protections (if constitutionally possible) and risk having a vast number of people injured to whom the government may not be able to offer compensation.
6. Countries that have no-fault vaccine-injury compensation systems could incorporate COVID-19 vaccines into these programs.
7. WHO has an insurance mechanism for vaccines under emergency use authorizations.Under this, the recipient country is required to agree to indemnify the WHO, donors, manufacturers, and healthcare workers who vaccinate people. The WHO provides compensation to people who have a serious adverse event. While the program is small in scale, but it could be beneficial for small countries.
8. A COVAX compensation system could be funded by reserving resources from higher-income countries or by charging manufacturers a per-dose tax to support its purpose. Billions of doses of COVID-19 vaccine will probably be administered; a 5- or 10-cent charge per dose would be enough to build a pool of resources for compensation.  

[Source: https://www.nejm.org/doi/full/10.1056/NEJMp2030600 ]

1128: Public transport in Italy - One of the places where the risk of contracting COVID-19 is highest

During the summer, while infection rates were still low, an 80% maximum capacity was set by the government on buses and metros. However, only few controls are in place to enforce the limit.

At 80%, it is impossible to keep the safety distance of at least 1 metre between the passengers.

Italy was the first European country to be hit hard by COVID-19 in the spring. It controlled the outbreak by the summer through a two-month strict lockdown. However, the daily cases have been rising exponentially over the past two weeks, hitting a new record of almost 22,000 on Tuesday.

[Source: Reuters]

1129: Healthcare workers and their families account for one in six (17.2%) hospital admissions in the working age population (18-65 years)

A study from Scotland, published online in BMJ, stated that while hospital admission with COVID-19 in this age group was very low, the risk for healthcare workers and their families was higher in comparison with other working age adults.

Admission to hospital with COVID-19 was not common in this group, with an overall risk of <0.5%. Healthcare workers and their households accounted for 17.2% of all COVID-19-related hospital admissions, despite representing only 11.2% of the working age population.

Patient-facing healthcare workers were found to be three times more likely to be admitted to hospital for COVID-19. Members of their households were about twice as likely to be admitted to the hospital for COVID-19 compared to other working age adults.

Among healthcare workers who were admitted to the hospital, one in eight were admitted into critical care and six (2.5%) died. Among admitted household members, one in five were admitted to critical care and 18 (12.9%) died.

[Source: Medscape]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA