Understanding Covid Vaccine Effectiveness Over Time—Bridging the Gap Between Public Health and Healthcare

What if you could track which Covid-19 vaccine was given, when and what the clinical evaluation revealed for each patient seen in a healthcare facility? It then explores the efficacy of vaccines, how that efficacy changes over time, how new virus strains alter it, and what virus and host characteristics (including underlying diseases) confer immunity. Gain near real-time insight into what leads to breakthrough infections in affected people. Such tracking includes robustness between clinical outcomes (including details of clinical interventions and laboratory studies), data on specific vaccines administered and dates of administration, and information on the status of the pandemic in relevant geographic regions. I need a good link.

This initiative is not an act of drawing a futuristic vision. Tightly integrated population-based health institutions in countries such as Israel directly inform public health policies, such as recommendations for tertiary vaccination in millions.¹ Unfortunately, these successes highlight relative failures in connecting public health and healthcare elsewhere. In most high-income countries, immunizations are recorded in electronic databases (registers) for public health purposes. However, even when a patient’s clinical history is recorded in an electronic health record (EHR), information about the relationship between a specific vaccination history and the relevant clinical history is not readily available from the healthcare system.

We address this challenge in our own work with an international voluntary consortium (currently comprising 9 countries and 335 hospitals) that has been steadily analyzing the clinical trajectory of Covid since March 2020. I am specifically aware (www.covidclinical.net). We used a variety of analytical and ‘boots in the field’ data validation and validation techniques to gain insight into the clinical course of Covid in hospitals across different waves of the pandemic.² Nevertheless, we are all well aware of the information gap that exists between public health and clinical care. Countries with universal health identifiers such as France, Singapore, Italy and Germany (the United States has not yet), the process of integrating immunization data with health records is the subject of a multinational e-health initiative and the 2018 strategy of the European Commission on the Digital Transformation of Healthcare.

At the same time, several hospital systems, including some in the United States (such as Keck Medicine in California)³), have bridged this gap by implementing their own (or designed by EHR vendors) systems for matching individual clinical records with state or national vaccination registries. level of success.^Four Although these systems are an exception, they show potential to bridge this critical gap between public health and clinical care. It also presents a U.S.-specific challenge where immunization data stored in the state registry since the last visit is not automatically updated in her EHR unless the patient returns to the hospital for treatment. increase.

Desiderata to bridge the gap between clinical and population health data on Covid vaccination.

What can we learn from hospital systems that have bridged the gap between immunization registries and patient EHRs? table, several factors will enable more health systems and governments to close this gap between public health and clinical care in the near term. Although not required, a commitment to involve local clinical leadership in dialogue with local public health authorities and to implement a much simpler software process than was required of EHR vendors and purchasers. need. recent past.

Specifically, hospital systems contact existing patients and systematize new immunization data (images of immunization records or from increasingly standardized smartphone apps like those in Massachusetts and California). You can ask us to transfer your immunization data? Each hospital would then have a complete and reliable record of immunizations, including combination vaccines that match the patient’s medical history, independent of the most recent patient visit. Data should be reconciled unless the patient participates.

This proposal is far from a panacea. The bridging gaps described here are of interest only to countries and health systems where comprehensive HIS EHR systems are deployed on a large scale. It also does not address additional steps that could be taken to further improve public health, such as exporting clinical data from the EHR to state or national registries. Nor have we addressed the real-time aggregation of data on the clinical course of patients in relation to their vaccination history. This is not recognized by viruses, but should be recognized by regulations. More importantly, the difficult basic logistics of “last mile” vaccine delivery.^Five We also know that some experts would argue that a systematic nationwide upgrade of health information infrastructure is preferable to a disease-specific, incremental patchwork approach.

Despite these limitations, we have focused on this small gap between registries and EHRs. Because this gap can be easily closed in the short term, it will have immediate clinical and public health utility, such as capturing a potential second surge in omicron infections now emerging in Europe, Because it can help. As a bridgehead for a broader and more ambitious effort to link clinical medicine and public health in the future.