PDF(Pubmed)
Abstract：
Ensuring that malaria vaccines deliver maximum public health impact is non-trivial. Drawing on current research, this article examines hurdles that malaria immunization may face to reach high-risk children and explores the policy implications. The analysis finds health system related risks with the potential to reduce the ability of malaria vaccines to provide equitable protection. Deployment of effective frameworks to tackle these risks so as to strengthen within-country equity and progress tracking should be entangled with the deployment of the vaccines. To capture more comprehensively disease- and system-related risks to child health and survival, vaccine allocation criteria should expand their data and indicator breadth. Factoring molecular, clinical, and epidemiological features of antimalarial drug resistance into vaccine allocation frameworks is critical to effectively reflect current and future risks to malaria control interventions. It is proposed that approximately 6-15 children would need to be vaccinated to prevent a malaria adverse outcome. Vaccine purchasing and delivery costs may overwhelm endemic countries\' health systems given the sizeable number needed to vaccinate, the population of at-risk children, and limited government financing of the health sector. Innovations in health financing are pivotal to ensuring the cost-effectiveness and sustainability of immunization programs aiming to attain and maintain universal and equitable protection.
摘要：
确保疟疾疫苗产生最大的公共卫生影响并非微不足道。根据目前的研究，本文探讨了疟疾免疫接种在高危儿童中可能面临的障碍，并探讨了政策含义。分析发现与卫生系统相关的风险有可能降低疟疾疫苗提供公平保护的能力。部署有效框架应对这些风险，以加强国内公平和进展跟踪，应与疫苗的部署纠缠在一起。为了更全面地捕捉与疾病和系统相关的儿童健康和生存风险，疫苗分配标准应扩大其数据和指标广度。分解分子，临床,将抗疟疾药物耐药性的流行病学特征纳入疫苗分配框架对于有效反映疟疾控制干预措施当前和未来的风险至关重要。建议大约6-15名儿童需要接种疫苗，以防止疟疾的不良后果。鉴于接种疫苗所需的相当数量，疫苗采购和交付成本可能会使流行国家的卫生系统不堪重负，处于危险中的儿童，以及政府对卫生部门的资助有限。卫生筹资方面的创新对于确保旨在实现和维持普遍和公平保护的免疫计划的成本效益和可持续性至关重要。
