| Title:
|
Beyond the jab: A need for global coordination of pharmacovigilance for COVID-19 vaccine deployment |
| Published:
|
2021-06-03 |
| Journal:
|
EClinicalMedicine |
| DOI:
|
10.1016/j.eclinm.2021.100925 |
| DOI_URL:
|
http://doi.org/10.1016/j.eclinm.2021.100925 |
| Author Name:
|
Naniche Denise |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/naniche_denise |
| Author Name:
|
Hotez Peter |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/hotez_peter |
| Author Name:
|
Bottazzi Maria Elena |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/bottazzi_maria_elena |
| Author Name:
|
Ergonul Onder |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/ergonul_onder |
| Author Name:
|
Figueroa J Peter |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/figueroa_j_peter |
| Author Name:
|
Gilbert Sarah |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/gilbert_sarah |
| Author Name:
|
Gursel Mayda |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/gursel_mayda |
| Author Name:
|
Hassanain Mazen |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/hassanain_mazen |
| Author Name:
|
Kang Gagandeep |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/kang_gagandeep |
| Author Name:
|
Kaslow David |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/kaslow_david |
| Author Name:
|
Kim Jerome H |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/kim_jerome_h |
| Author Name:
|
Lall Bhavna |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/lall_bhavna |
| Author Name:
|
Larson Heidi |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/larson_heidi |
| Author Name:
|
Sheahan Timothy |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/sheahan_timothy |
| Author Name:
|
Shoham Shmuel |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/shoham_shmuel |
| Author Name:
|
Wilder Smith Annelies |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/wilder_smith_annelies |
| Author Name:
|
Sow Samba O |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/sow_samba_o |
| Author Name:
|
Strub Wourgaft Nathalie |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/strub_wourgaft_nathalie |
| Author Name:
|
Yadav Prashant |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/yadav_prashant |
| Author Name:
|
Batista Carolina |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/batista_carolina |
| sha:
|
bfd543c74bb2e22101fef124e14cc32a877fbfbf |
| license:
|
no-cc |
| license_url:
|
[no creative commons license associated] |
| source_x:
|
Elsevier; Medline; PMC; WHO |
| source_x_url:
|
https://www.elsevier.com/https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/https://www.who.int/ |
| pubmed_id:
|
34099998 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/34099998 |
| pmcid:
|
PMC8173024 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173024 |
| url:
|
https://doi.org/10.1016/j.eclinm.2021.100925
https://www.ncbi.nlm.nih.gov/pubmed/34099998/
https://api.elsevier.com/content/article/pii/S2589537021002054
https://www.sciencedirect.com/science/article/pii/S2589537021002054 |
| has_full_text:
|
TRUE |
| Keywords Extracted from Text Content:
|
CanSino vaccines
cerebral venous
H1N1 swine
Sinovac
COVID-19
Oxford/Astra-Zeneca
Vaccine
[1]
[7]
COVID-19 vaccines
AEFI
bodies
Pfizer/BioNTech
vaccine network
H1N1 vaccine
AESIs
COVID-19 vaccines [8
COVID-19 vaccine
intravascular
SARS-CoV-2
https://www.journals.elsevier.com/eclinicalmedicine
herd |
| Extracted Text Content in Record:
|
First 5000 Characters:As of March 2021, over 40 COVID-19 vaccine candidates were either in phase 3 clinical trials or had received conditional approval for emergency use [1] . The Pfizer/BioNTech, Moderna, Oxford/Astra-Zeneca and Johnson and Johnson vaccines have been approved for emergency use by multiple regulatory authorities. The Gamaleya Sputnik-V, Sinopharm, Sinovac and CanSino vaccines have been approved for emergency use in many countries though not yet by stringent regulatory authorities. By April 2021, over 950 million vaccine doses had been administered worldwide but distribution has been very unequal; 40 doses/100 individuals in North America vs 1.1 doses/100 individuals in Africa [2, 3] .
The roll out of vaccines requires robust pharmacovigilance systems and global coordination of post-licensure surveillance [4] including real-time information sharing, open source data repository and a strong communication component. The WHO Global Vaccine Safety Initiative aims to standardize reporting of adverse events following immunization (AEFI) and adverse events of special interest (AESI) [5] . The WHO manual for COVID-19 vaccine safety surveillance outlines the minimum requirements at global, regional and national levels for passive surveillance with the ability to detect and investigate AEFIs, safety signals or clustering events as well as determine causality for defined AESI [6] Countries with well-established pharmacovigilance systems are encouraged to establish active surveillance to investigate AESIs through cohort monitoring, sentinel surveillance or e-Health platforms.
It is plausible to envision that many well-established regulatory authorities and pharmacovigilance platforms may be overwhelmed by the sheer number of AEFIs reported over the next year as rollout continues. The 2009 H1N1 swine flu influenza pandemic and vaccination roll out taught us that few countries' pandemic preparedness
EClinicalMedicine journal homepage: https://www.journals.elsevier.com/eclinicalmedicine plans adequately addressed vaccine safety monitoring [7] . Pharmacovigilance platforms were unable to confirm or exclude associations between AEFIs and the H1N1 vaccine and this contributed to eroding vaccine confidence. Thus, global coordination with scientists, medical and public health professionals, and pharmaceutical/manufacturing companies, along with increased capacity to analyze and report realtime events are of paramount importance to ensure robust pharmacovigilance of COVID-19 vaccines [8] . By definition, very rare AEFIs (< 1/10.000) are usually not detected prior to licensure but rather once vaccines are widely used within a countries' immunization programs. In the setting of global COVID-19 vaccine introduction, extremely rare AEFIs such as thrombocytopaenia, disseminated intravascular coagulation, or cerebral venous sinus thrombosis were identified and reported in some countries through their robust pharmacovigilance systems, confirming that these systems work as expected. Based on these systems, regulatory bodies and advisory committees evaluate the data and risk-benefit to make determinations of any changes in use. This can lead to temporary pauses in vaccination for further evaluation, and/or to a recommendation to add potential rare adverse events to the product information.
Given the extensive global media coverage, accurate and widespread communication is critical to convey complex messages relating to signal evaluation, causation and risk-benefit at a time when news is increasingly consumed through the filters of social media and internet search algorithms. Thus, robust and transparent pharmacovigilance programs must be coupled with sophisticated communication strategies and international efforts to combat vaccine misinformation which can erode trust, create social discord and promote one vaccine over others for financial or political interests [9] .
In addition to the standard vaccine safety surveillance issues, COVID-19 vaccines pose additional challenges to post-licensure surveillance, complicating the risk-benefit assessment of safety signals. These include multiple authorized or approved vaccine types, potential interchangeability of vaccine types, dose interval flexibility and, high comorbidities in the target population. Additional concerns may emerge as the Covid19 vaccines are rolled out in low-and middleincome countries (LMIC) where a high prevalence of malnutrition and infectious diseases may impact the type of AEFIs and immune responses observed in the context of less robust pharmacovigilance programs. The Brighton Collaboration (https://brightoncollaboration. us) global research safety vaccine network) has harmonized global safety assessment tools and definitions for COVID-19 vaccines which are regularly updated.
Challenges still lie ahead to ensure alignment, transparency and interconnectivity across different systems and rapid feedback from national to global level. This should involve broad stakeholders at g |
| Keywords Extracted from PMC Text:
|
PH
COVID-19
GK
SARS-CoV-2 vaccine
Vice
ViiV
Janssen Pharmaceuticals
SS reports grants
GlaxoSmithKline
Amplyx
MEB
T2
Bill
CEPI
Cidara
COVID-19 vaccines
BMGF
Merck Vaccine
Ansun BioPharma
Immunome
F2G
SK biosciences
HL reports grants
Acidophil
SaudiVax |
| Extracted PMC Text Content in Record:
|
First 5000 Characters:MEB and PH are developers of a COVID-19 vaccine construct, which was licensed by Baylor College of Medicine to Biological E Ltd., a commercial vaccine manufacturer for scale up, production, testing and licensure. MG participates in one of eight SARS-CoV-2 vaccine development projects supported by The Scientific and Technological Research Council of Turkey (TÜBİTAK) since March 2020. SG is cofounder of Vaccitech and has a patent on ChAdOx1 nCoV-19 licensed to AstraZeneca. MH is Founder and Managing Director of SaudiVax. JPF and GK are members of the WHO SAGE Working Group on COVID-19 vaccines. GK is independent director of Hilleman Laboratories Private Limited and Vice Chair of the Board, Coalition of Epidemic Preparedness Innovations (CEPI). DK reports grants from Bill and Melinda Gates Foundation (BMGF) and grants from CEPI. JK reports personal fees from SK biosciences. HL reports grants and honoraria from GlaxoSmithKline for training talks and from Merck as a member of the Merck Vaccine Confidence Advisory Board, outside the submitted work. TS reports grants from National Institute of Allergy and Infectious Disease and Fast Grants and research contracts from GlaxoSmithKline, and ViiV Healthcare. SS reports grants from Ansun BioPharma, Astellas Pharma, Cidara Therapeutics, F2G, Merck, T2 Biosystems, Shire Pharmaceuticals, Shionogi, and Gilead Sciences, outside the submitted work; and personal fees from Amplyx Pharmaceuticals, Acidophil, Janssen Pharmaceuticals, Reviral, Intermountain Healthcare, Karyopharm Therapeutics, Immunome, and Celltrion, outside the submitted work. All other authors declare no conflict of interests. The authors views and opinions in the Commentary do not necessarily represent the views, decisions, or policies of the institutions, universities, or health systems with which they are affiliated. |
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