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‘Chronic disease criteria too broad to prioritize Covid-19 vaccination’

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‘Chronic disease criteria too broad to prioritize Covid-19 vaccination’

The government said it would prioritize adults aged 19-65 with chronic diseases to receive Covid-19 vaccination.

However, experts urged the government to set more detailed criteria to define which group with chronic diseases can get Covid-19 vaccines first.

According to the Korea Disease Control and Prevention Agency (KDCA), the government will roll out the first Covid-19 vaccines to vulnerable groups, including the elderly, residents of nursing homes, those with chronic diseases, and healthcare workers.

Recommended groups for priority vaccination include workers at medical institutions, residents and workers at communal facilities, the elderly, adults with chronic illness aged between 19 and 64 with moderate or higher risk, employees at pediatric and adolescent education and childcare facilities, first Covid-19 responders, police, firefighters, and soldiers.

The inclusion of adults with chronic diseases is quite unusual compared to the criteria in other countries and international organizations, experts said.

The WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) recommends priority vaccination to high-risk healthcare professionals and the elderly.

The U.S. Advisory Committee on Immunization Practices (ACIP) puts medical staff and nursing home residents at the top, followed by nursing home residents, the elderly, and people in essential services.

In the U.K., the Covid-19 vaccination guidelines state that the elderly and workers staying at nursing homes should get the vaccines first. Seniors aged 80 or more and healthcare workers come next, followed by the elderly aged 75 or more. Adults aged 16-65 with chronic diseases come at the sixth.

The problem is that there are too many people with chronic diseases in Korea.

According to government data, 18.8 million Korean people sought medical help due to 12 chronic diseases in 2019. Patients with hypertension were the largest group, with 6.5 million, followed by 5 million with arthritis, 3.4 million with mental and behavioral disorders, 3.3 million with nervous system diseases, 3.2 million with diabetes, and 1.9 million with liver disease.

Such diverse chronic diseases need detailed segmentation to set priority for Covid-19 vaccination, observers said.

research team led by Professor Park Seong-mi at Korea University Anam Hospital recently published a study, saying young patients with cardiovascular disease risk factors had a higher risk of fatal outcome than elderly patients after Covid-19 infection.

The research team reviewed 9,878 cases literature and data collected from PubMed and EMBASE and conducted a meta-analysis on 51 papers on Covid-19.

The team found that cardiovascular disease and its risk factors — hypertension and diabetes — were closely related to fatal outcomes in Covid-19 for patients of all ages.

Moreover, when there were cardiovascular risk factors (hypertension, diabetes) and heart disease, patients younger than 50 years of age were twice as likely to have severe disease and death than those older than 60.

“The findings showed that not only old people but young patients with comorbidities are very vulnerable to Covid-19 infection,” Park said.

Kim Woo-joo, an infectious disease specialist at Korea University Guro Hospital, said most of the Covid-19 deaths came from patients with chronic diseases. “I think the government included the elderly and those with chronic diseases in the priority vaccination list because they wanted to curb the fatality rate,” he said.

When selecting priority groups for vaccination, the government should check the effect and characteristics of vaccines carefully, he said.

“A vaccine’s efficacy can be divided into three — infection prevention, severe disease prevention, and death prevention. It is yet clear whether Pfizer’s vaccine or that of Moderna will be effective to prevent young people from Covid-19 with no symptoms,” Kim said.

Therefore, the priority should be set based on all aspects, including the disease’s characteristics and the vaccine’s effectiveness, he added.

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