Why do the "fragile" elderly people unwilling to get a new crown vaccine?

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Rare adverse reactions and serious side effects on the new crown vaccine

And its impact on basic diseases

Perform full scientific research, and publicize data in time

Establish a bad reaction monitoring of "Guangsha.com"

Is the key to cracking the vaccine hesitation

On June 2, at the press conference held by the State Council's joint prevention and control mechanism, Lei Zhenglong, deputy director of the National Health and Health Commission Disease Control Bureau and first -level inspector, said that as of June 1 The number of people exceeded 230 million, and 218 million people completed the whole process, and the immunization was strengthened by 169 million people. This means that nearly 13 % of the elderly over 33 million over 60 years still have not yet vaccinated. Compared with two months ago, this gap has not changed much, and the enhanced needle has more than 95 million elderly people over 60 years old.

At present, the total population of China's total vaccination of new crown vaccines has reached 89.07 %, but the vaccination disorder of the elderly has become one of the largest shortcomings of epidemic prevention. In contrast, in most European and American countries, the full vaccination rate of elderly people over 60 years of age has long reached more than 85 %, or even more than 90 %. The world has entered the "vaccine era" for two and a half years. In addition to the discussion of confirmation, new crown death, mask and airplane travel, the most lively topic is the vaccine suspicion and the vaccine hesitant. How to defend the elderly, improve the vaccine vaccination rate, and how to break the vaccine hesitation? Which of the elderly in foreign countries can be used as a reference in China?

Oversized vaccine contraindications

In Germany, as soon as Christmas in 2020 passed, many white -haired elderly people began to lift the vaccine for the team. Earlier, they all received a paper letter from the government, which gave a clear arrangement for their inoculation order: first starting with the elderly over 80 years old, followed by 70 years old, and then 60 years old. Another group that was vaccinated with it was sorted according to the danger of the disease in the popularity of the body. People with chronic kidney or liver disease, HIV or other immune defects, heart disease, asthma, and clinical obesity will significantly increase the probability of severe illness after the new crown.

The rigorous and orderly style of the Germans has a typical manifestation in its vaccination plan. Similar to Germany, most European and American countries start vaccination with the most vulnerable elderly people in formulating vaccine vaccination strategies, which forms a path on the path with China. In China, the initial priority vaccination object is not high -risk groups such as the elderly, but medical staff, airports, railway stations, and high -risk groups such as logistics, and takeaways with strong liquidity.

Chen Xi, an associate professor of global health and economics in Yale University in the United States, explained to China News Weekly that there are very few people in China in China in the early domestic new crown virus. In other words, from the beginning, the vaccine protection data related to the elderly has insufficient data. Later, the third phase of the clinic was carried out. Although "add" some samples of the elderly, in general, the adverse reactions may occur for the elderly with the elderly with basic diseases. Great grasp. " Therefore, at the beginning of the promotion of the vaccine, China adopted a relatively conservative and cautious strategy to the elderly vaccination.

It was not until March 2021 that under the premise of fully assessing the risk of infection, China began to carry out vaccination of elderly people over 60 years of age in various places. In March of this year, the first research of the Argentine National Popular disease and the Director of the National Strategic Information Bureau Analía Rearte revealed the efficient research of the elderly for the elderly for the elderly, and published it in the "Liuye Knife". Large samples from Argentina show that the 60 -year -old and above elderly people will reduce the risk of death by 85 % after injection of two doses of national medicine vaccines. Previously, phase I/II clinical data only showed that "compared with people aged 18 to 59, the neutralization of antibody titration after vaccination after vaccination of the elderly over 60 years old is slightly lower, but the safety is good."

Lu Mengji, a professor at the Institute of Virus Research at the University of Essen University of Medicine at the University of Essen, believes that if the priority of vaccination is in order, because the main domestic threats from the country come from input, in order to keep the production and life continue to stabilize, at high risk at high risk, There is no problem choosing the former between crowd and high -risk people. But the biggest problem is that when the elderly were promoted, they did not really implement it. The artificially set up many elderly people's inoculation obstacles, such as too loose and lack of clear standards. In the early days, some elderly people wanted to go to community vaccination, but they were rejected because they had chronic diseases such as hypertension and diabetes. This "conservative" was due to lack of scientific data to confirm the safety of the elderly. In the opposite of Europe and the United States and other countries, the more "extremely vulnerable people" with chronic diseases, the more it is strongly recommended to vaccinate the vaccine as soon as possible, because such people are "the most dangerous" after infection.

In fact, there is no "absolute contraindication" in foreign vaccination guidelines. Generally only reminds some serious side effects with data support. In the "Technical Guide of the New Correction Virus vaccination technology (first edition)" released by China in March 2021, the contraindications of vaccination include "the acute attack period of chronic diseases, or patients with unconventional severe chronic diseases". Taking hypertension as an example, although not directly written taboos, patients are often required to suspend vaccination because they fail to control high blood pressure. In the early days of practice, because there were no clear standards, they often relying on grass -roots vaccination personnel to weigh themselves by themselves, leading to various confusion. On May 31, 2021, in Tokyo, Japan, some elderly people lined up in vaccination. Picture/Surging Image

After Hong Kong introduced the Kochi activity vaccine in February 2021, it also adopted the same taboo guide as the Mainland in the early days. Jin Dongyan, a virusist at the University of Hong Kong, still remembers that many contraindications were listed at that time. Many medical staff were very loose when they prescribed the medical certificate of "inaccurate vaccine" to the elderly. That is to have a basic disease that cannot be vaccinated, "this impact is very bad." In fact, these contraindications lack the scientific basis. In the later period, the Hong Kong Special Administrative Region Government canceled "all these contraindications", and only stipulated that very few people who were allergic to vaccine ingredients, or patients with chronic diseases were "not beaten" in the critical stage. "It can only be said that the dead sheep is particularly late." Jin Dongyan said.

Among the 5435 people who died in the fifth wave of Hong Kong, more than 70 % were elderly people over 80 years old, and about 88.3 % did not vaccinate two new crown vaccines. Before the fifth wave of epidemic outbreak, as of the end of 2021, less than half of the elderly in the age of 65 and over, only less than half of the new crown vaccines were vaccinated. By April 6, 2022, the two -dose vaccination rate for the elderly over 60 years of age had reached 73.62 %.

How can Hong Kong achieve the surge in the age of age in the short term? Jin Dongyan pointed out that on the one hand, the higher mortality rate of the elderly in the fifth wave of epidemics has given many people a "blood lesson". At the same time, the government also sent a special medical team to the vaccination for the nursing homes with a low vaccination rate, and let the doctors come to the door to communicate the safety and effectiveness of the vaccine with the elderly and their families to answer their confusion for them. On the other hand, the most important point is that the government disclosed the detailed data of the two vaccines in the fifth wave of epidemic. For people over the age of 60, after completing the three -dose to enhance the vaccination, the anti -severe effect of the Koxing vaccine is 97.9 %. The MRNA vaccine developed by Pfizer and Biontech The effective rates of Hefitai Defense were 98.3 % and 98.1 %, respectively. If two doses are completed, the effective rates of Kexing and Fubai's severe disease are 72.2 % and 89.6 %, respectively; the effective rate of preventing death is 77.4 % and 92.3 %. At the same time, the adverse reactions of the vaccine are also disclosed. "Data facts are better than arguing," he said.

In addition, it is worth noting that although most of the fifth wave of epidemic is a breakthrough infection, research shows that this does not mean that the vaccine will fail. In fact, the virus load of the breakthrough infection is lower than the general infection. The original person would have 5-7 days to produce antibodies in the body. Now it only takes 2 to 3 days. , I made a special effect of special effects, so the course of the disease and low contagiousness, so I do not need to beolate for 7 days.

In addition to security, there are more complicated problems

"Of course the elderly who need the vaccine most, but what if they have more serious side effects after vaccination?"

Since the second half of 2020, Amelia Fiske, a medical anthropologist at Munich University in Germany, has begun to communicate with a large number of Germans to vaccine. One of the interview objects said this to her. At this time, it was the last stage of Germany's approval of Pfizer/Biontech vaccine and Moderna vaccine. FISKE found that throughout Europe, Germany's skepticism of vaccines in Germany was high.

Another research team from Munich University of Technology from April to July 2021, a crowd investigation of eight European countries such as Germany and France found that the main reason for the hesitation of the elderly vaccine was the fear of side effects. For example, some people are worried that they will exacerbate chronic diseases, and others think that the MRNA vaccine will bring "genetic transformation", or the Astraon vaccine may cause thrombosis. Some fierce opponents even call the vaccine as "poison".

Lu Mengji analyzed that from a scientific perspective, the reason for these fear was untenable. All the final vaccines must be strictly strictly clinical trials, and a large amount of security data will be collected during this period. If any adverse reaction occurs, it will stop immediately. After the vaccine is listed, the vaccine research and development enterprises and government regulatory agencies will continue to track the vaccine safety to identify some rare adverse reactions with less than one tenth of 10,000 or even 100,000.

So far, there are only two rare adverse reactions discovered by the new crown vaccine: one is related to the MRNA vaccine, and it is found that it may cause rare myocarditis or pericarditis. Moreover, the data collected worldwide showed that the probability of incidence was extremely low, and there were only four cases per 100,000 pins. Most of the symptoms were mild. It could reduce the risk by extending the interval of the first and second doses. Another adverse reaction is even more rare, with an incidence of only one millionth, which appears after vaccination such as Johnson & Johnson and Astraon. Relevant monitoring found that after the vaccination was vaccinated, the disease mortality rate was as high as 20 % of the symptoms of thrombosis after vaccination. After that, the new crown vaccinations of European and American countries are mainly MRNA, and adenovirus vaccines are assisted or supplemented. There are strict data support behind these discoveries, and public health institutions in various countries have also warned and reminded in the national vaccination guidelines. The real side effect of the vaccine is a severe allergic reaction. Unlike general allergic reactions such as pollen allergies, severe allergic reactions brought by vaccines sometimes endanger their lives. Symptoms such as dyspnea, blood pressure decrease, tongue or throat swelling, whole body rash or urticaria, and allergic shock. If it is acute, generally appears within 15 minutes after vaccination, the vaccination point will be equipped with adrenaline, and there is usually no serious consequences after timely treatment. According to the data collected from December 2020 to January 2021, the US Disease Control and Prevention Center (abbreviated by CDC) showed that the report rate of severe allergic reactions of Pfizer/Biontech vaccine was only 4.7 cases/million doses. Million doses.

As for the basic disease of the elderly, a study published in "Natural Communications" in January 2022 shows that elderly people with a variety of basic diseases will not bring additional adverse reactions after vaccination. This is a large sample research. Researchers from the Li Ka -shing Medical College of Hong Kong University use the vaccination records of the public medical care database and the Department of Health in Hong Kong. , Twenty -chronic diseases such as thyroid dysfunction, chronic lung disease, rheumatoid arthritis, and Parkinson disease. Studies have pointed out that vaccine safety is a major public health problem and the key to solving the hesitation of vaccine. The significance of this study is to make the public clear that they should give priority to vaccination of these "fragile people".

"In fact, in Europe and the United States, it has formed a consensus on this." Lu Mengji told China News Weekly. He pointed out that after Germany as an example, after the large -scale vaccination began to vaccine, in addition to a few stubborn people who resolutely resisted the vaccine, most of the elderly thought they would benefit from the vaccine. Compared with China, this was a cognitive difference.

Why does this consensus be formed? Lu Mengji said that this is a specific study based on a large amount of data analysis. For example, what is the severe and mortality rate of the severe age between the age of 60? How much to increase the severe increased rate and mortality after each basic disease is superimposed? If the elderly are given priority to the elderly within three or four months, how much will the number of hospitalizations and deaths be reduced? "These are clearly clear in the model." So how do the elderly benefit from the vaccine? Germany is not just general talk. There are data behind all conclusions and very detailed. When government public health agencies further divided different categories of "fragile crowds", each category could be "settled". Almost all of them were published at that time. thorough". In other words, it is science behind cognition and system.

Based on this, FISKE quickly discovered that compared with other European countries, after the formal starting mass of Germany, the phenomenon of "vaccine hesitation" of the elderly was particularly obvious. The Vaccine Institute of Vaccination (Stiko) under the German public health institution Robert Koch Research Institute (RKI) is specifically responsible for formulating an official vaccination plan. Thomas Mertens, the person in charge of Stiko, pointed out that the vaccination of "success" must meet the following. Points: strong public health infrastructure, the public's widespread trust in government vaccine regulatory agencies, as well as clear communication with the necessity, effectiveness and any potential side effects of the health authorities and the public around the vaccine.

Behind the vaccine of the elderly, not only the safety itself of the vaccine itself, but also a complex issue with epidemiology, biology, social psychology, ethics, and communication.

"Guangsha.com" adverse reaction monitoring

In January 2021, when the US anti -vaccine organization Children's Health Defense ("Protecting Children's Health") published a data involving a death incident involving vaccine death, Crowd Tangle, a social media analysis tool, showed that in less than a week, The article has received more than 15,000 interactions and more than 6,000 sharing on Facebook.

The article pointed out that since the U.S. Food and Drug Administration (FDA) in December 2020 "urgently authorized" Pfizer/Biontech and Moderna vaccine, by the end of December, the US vaccine bad incident report system (VAERS) recorded a total of 3916 adverse reactions. In the incident, 13 of them died, nine people died of Pfizer/Biontech vaccine, and 4 died of the Moderna vaccine. Three of them were over 60 years old. Before the death, the symptoms were "spitting foam" and "severe heart disease seizures". In response, VAERS immediately responded, "The adverse reactions reported to VAERS, including any health problems that occur after vaccination, usually cannot prove that the vaccine constitutes a cause and effect." It constitutes a cause and effect. The critical links directly related, if there is only a time in time, it is like a car accident after vaccination. Although it will also be attributed to adverse reactions, it is obvious that death is not caused by the vaccine. This is called "occasion".

On October 5, 2021, in a horse -up company in the outskirts of Kuala Lumpur, Malaysia, workers packaged local filled China Kexing New Crown vaccine. Picture/Xinhua

In actual investigation, the judgment of cause and effect is very complicated. At the press conference of the State Council ’s joint prevention and control mechanism on May 27, when the reporter mentioned the voice of“ leukemia and vaccine -related vaccine after vaccination after vaccination ”, Wang Huaqing, chief expert of the China Centers for Immunization Planning, pointed out In addition to the association of time, we must also comprehensively consider the rationality of biology, the intensity of statistical association, and whether the incidence of symptoms after vaccine is higher than the daily baseline level.

Before the judgment, the first step to be carried out is to collect all adverse reactions related to vaccine -related adverse reactions in a wide range. As an important part of vaccine safety supervision, European and American countries have a set of monitoring mechanisms based on poor vaccine reporting systems. Taking the American VAERS system as an example, it is established by FDA and CDC. Any ordinary vaccinator, medical structure, and vaccination center can report bad events on the system. In 2005, even a anesthesiologist claimed to report to the system that he had the symptoms of "Hulk" after vaccination. His skin became green and muscular swelling. He began to have a tendency to anger. The system also received his report.

According to US CDC data, for all types of vaccination, 37 % of the adverse reaction reports in VAERS come from vaccine manufacturers and 36 % from medical care providers, and only 7 % of the vaccine receiver or their guardians are directly.

In the UK, this system is called "Yellow Card", which is also open to the public and medical institutions. The British drug surveillance agency operating the "yellow card" also emphasized: "In any case, some incidents may have happened, especially after millions of people have vaccinated, and most vaccines are vaccinated to older people and potential basis for potential foundations. People with diseases. "In addition, Germany also developed a mobile app called Safevac 2.0 as a supplement to the report system of adverse reactions. With this application, in addition to suspected adverse reactions, the system can also obtain percentage of tolerances who tolerate the vaccine, which is more convenient for quantitative evaluation of possible adverse reactions. The more participants, the more meaningful the corresponding data.

It is through this "Guang Sa" method that FDA discovered rare thrombosis caused by rare myocarditis and adenovirus vaccines related to the MRNA vaccine. The judgment basis is mainly compared with the people who have not been vaccinated, and the incidence of related adverse reactions has increased significantly.

As of April 4, 2021, according to the adverse reaction information collected by the European Drug Alert Database, in the European Economic Zone and the United Kingdom, 169 of the 34 million people in the first dose of Astraikon vaccine occurred. The overall incidence of thrombosis and 53 cases of visceral vein thrombosis was about 6.5 cases/100,000. According to a report from VAERS in the United States, women aged 18 to 49 have vaccinated the maxia adenovirus vaccine, and the incidence of thrombosis with platelet decrease is 7 cases/100,000. Among the general population who has not vaccinated any vaccine, the year of the cerebral venous thrombosis The incidence is only 0.22 ~ 1.57 cases/100,000. During the same period, this kind of case was not found after vaccination of 97 million doses of Pfizer/BIONTECH vaccine. After the vaccination of more than 84 million Moderna vaccination, only 3 cases of severe cerebral venous sinus thrombus appeared without platelets.

In contrast, the VAERS system also reported multiple cases of Bell Paralympic incident after the Pfizer/BIONTECH vaccine, but the FDA concluded after reviewing, "the frequency of the observed report of Bell Paraception is the same as the expected background incidence of the general population". " Therefore, there is no evidence that there is no evidence that there is a correlation between the new crown vaccine and Bell palsy. These cases show that only as possible based on as many cases, more accurate comparative data will be obtained. Especially in Lu Mengji, this is extremely critical to judge a very small number of serious adverse reactions, and also affects the choice of vaccination strategy of "fragile groups" such as the elderly.

China also has its own reporting system. Since 2005, with the support of the World Health Organization (WHO), China has gradually established a "suspected prevention of vaccination abnormal response" (AEFI) monitoring system. However, unlike European and American countries, China's systems are not open to the general public, and reports are limited to medical institutions, disease control centers, vaccination points or pharmaceutical companies. This means that only the adverse reactions that the grass -roots doctors or diseases and control personnel believes that "the necessary" report will be reported, but from the overall rate of reporting, China is far lower than that of Europe and the United States. Moreover, the data of the adverse reactions of the vaccine is concentrated in the centers at all levels, and it is difficult for the public to obtain it. On May 28, 2021, the China Centers for Disease Control and Prevention first released the monitoring data of adverse reactions in my country's new crown vaccination. Data show that from December 15, 2020 to April 30, 2021, a total of 31,434 reports were received, with a total incidence of 11.86/100,000 doses, of which the incidence of severe abnormal reaction was 0.07/100,000 100,000 Times.

In contrast, from December 27th, 2020 to March 31, 2022, Germany's non -performing reaction report rate was 170/100,000 doses, and the report rate of severe adverse events was 20/100,000 doses. As of March 31, 2022, taking Kexing, which is also an active vaccine, the report rate of adverse events received by the Hong Kong Department of Health was 49.1/100,000 doses.

In addition, Europe and the United States will regularly disclose the adverse reactions collected by the collected vaccine. When Germany is the most frequent, it will be made public every month. Hong Kong's new crown vaccine safety inspection report will be announced every two months. The Mainland data was only announced once last May, and there are no symptoms of severe adverse reactions. There are no detailed explanations. China Disease Control in the official interpretation wrote: "Individuals also report bad events such as severe allergies. After evaluation, some severe allergic reactions may be related to vaccines. Other events are still in continuous monitoring and research. The current evaluation is considered to be serious abnormal reactions. The incidence is extremely low. "

Chen Xi pointed out "China News Weekly" that the opening of everyone is a very important mechanism design. If such a direct reporting system is lacking, only medical institutions will be difficult to open up the upward channel as an entrance to collect adverse reactions. The experience of the United States is to collect information through VAERS first. Since then, the internal expert review team investigates how these cases happen, whether it is really causal with the vaccine, or an occasional incident, but no matter what kind of, the final summary is typical. After the case, it is publicized through the official platform of CDC, which is a good public health education. "There are many rumors and false information dissemination on the issue of the elderly and children's vaccination. If the more specific adverse reaction data will be announced, the information will become more transparent, and the public's concerns may be reduced a lot."

Send 2022.6.13 Total Issue 1047 "China News Weekly"

Magazine title: Defending the elderly, what is the hesitation of vaccine?

Reporter: [email protected]

Edit: Du Wei

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