MEASURING THE LONG-TERM SAFETY AND EFFICACY OF COVID-19 VACCINES There is a need for accurate recording of any adverse events following administration of Covid- 19 vaccines. As these vaccines are new, we don’t yet have long-term data on their safety and efficacy.
This data is essential to help build public confidence in these vaccines and ensure take-up of the vaccines is high; not just in the UK but globally as well. The data will also help identify how frequently vaccination is needed to ensure vaccine recipients retain their immunity to Covid-19. The UK is well-placed to collect this The use of this data will be data. We have a National Health facilitated by the recently Service that has developed developed clinical codes for Covid- computerised medical records for 19 vaccines for recording use in general practices on a information in electronic medical population of around 67 million records. These codes include, for people. These electronic medical example, codes for whether people records provide longitudinal data on attended or did not attend for their people’s health and medical vaccination appointment; whether experiences. They can now also be they declined to be vaccinated; and linked to other data; such as whether they had a clinical contra- hospital admissions records and indication to being vaccinated. mortality records, as well as to the Other codes allow recording of the results of Covid-19 tests, increasing specific vaccine that was their value for monitoring the safety administered, which will be and efficacy of the new Covid-19 essential for comparing the long- vaccines. term safety and efficacy of different Covid-19 vaccines. The comprehensive nature of these medical records and the large The data from electronic medical population they cover means that records can be supplemented by they can be used to look at safety the reporting of any suspected and efficacy of Covid-19 vaccines in adverse events by health specific populations. This could be, professionals to the MHRA via the for example, by age, sex, medical Yellow Card Scheme. Vaccine history or ethnic group. It would recipients should also be also be possible to look at more encouraged to report any reactions serious health outcomes and death directly to the MHRA a well as to rates by linkage to other data sets. their doctor. This allows the MHRA Hence, planning how we would use to build up information on the these data is essential and needs to safety profile of the new Covid-19 start now. vaccines and advise patients and the public of any potential problems.
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PRESCHOOL WHEEZE PARENT GROUP: PUBLIC AND PATIENT INVOLVEMENT We are researching pre-school wheeze (1-5 years) and wanted to hear parents’ or carers’ experiences of visiting the doctors or hospital emergency department. Across four virtual sessions in March, parents and carers had the opportunity to share their experiences. Discussions involved communication and support in healthcare settings and access to healthcare during the Covid-19 pandemic. Parent involvement has helped shape our research, providing insights from a parent’s perspective. This follows our editorial, ‘Primary care of children and young people with asthma during the Covid-19 era’, being cited in the updated British Thoracic Society on asthma management during the Covid-19 pandemic.
CURBING THE SPREAD OF COVID-19 IN LOW INCOME COUNTRIES Globalisation impacts the epidemiology of communicable diseases, threatening human health and survival globally. The ability of coronaviruses to spread, quickly and quietly, was exhibited with Severe Acute Respiratory Syndrome in 2002–2003 and, more recently, with COVID-19. Not sparing any continent, the World Health Organization declared a COVID-19 pandemic on 11 March 2020. In an article published in the Journal of Royal Society of Medicine, we discussed how higher income countries can support the response to Covid-19 in low income countries. Despite high-income countries mortality and economic being inordinately impacted, due to devastation, these discussions have the increasing number of COVID-19 not involved low- and middle- cases, SARS-CoV-2 continues to income countries. COVID-19 may represent a looming threat to the cause unprecedented humanitarian Global South, leading the World health needs in countries already Health Organization to previously subjected to unaffordable, state that ‘Our biggest concern fragmented and fragile health continues to be the potential for systems; as COVID-19 unfolds a COVID-19 to spread in countries worldwide economic crisis, with the with weaker health systems’ and poor and other vulnerable groups that Africa could become the next affected disproportionately, epicentre. building health system resilience, through an urgent and coordinated However, while academics, public global response, that allocates health experts and resources and funds efficiently, macroeconomists discuss among must be prioritised in this dynamic themselves, using collaborative and shifting pandemic. strategies to reduce morbidity,
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Photo: Moderate non-proliferative diabetic retinopathy by K Viswanath Published in: Community Eye Health Journal Vol. 16 No. 46 2003 Creative Commons via FLICKR
ASSOCIATIONS BETWEEN ATTAINMENT OF INCENTIVIZED PRIMARY CARE INDICATORS AND INCIDENT SIGHT‐ THREATENING DIABETIC RETINOPATHY Our new study published in the journal Diabetes, Obesity and Metabolism shows a lower incidence of sight‐threatening diabetic retinopathy in people with type 2 diabetes who meet QOF targets for HBA1c, blood pressure and lipid control. We aimed to examine the impact of neighbour propensity score attainment of primary care diabetes matching was undertaken, and clinical indicators on progression to univariable and multivariable Cox sight‐threatening diabetic proportional hazards models were retinopathy (STDR) among those then fitted using the matched with mild non‐proliferative diabetic samples. Concordance statistics retinopathy (NPDR). were calculated for each model. We carried out a historical cohort A total of 1037 (5.5%) STDR study of 18,978 adults (43.63% diagnoses were observed over a female) diagnosed with type 2 mean follow‐up of 3.6 (SD 2.0) diabetes before 1 April 2010 and years. HbA1c, blood pressure and mild NPDR before 1 April 2011 was cholesterol indicator attainment conducted. The data were obtained were associated with lower rates of from the UK Clinical Practice STDR (adjusted hazard ratios [95% Research Datalink during 2010‐ CI] 0.64 [0.55‐0.74; p < .001], 0.83 2017, provided by 330 primary care [0.72‐0.94; p = .005] and 0.80 [0.66‐ practices in England. Exposures 0.96; p = .015], respectively). included attainment of the Quality and Outcomes Framework HbA1c Our findings provide support for (≤59 mmol/mol [≤7.5%]), blood meeting appropriate indicators for pressure (≤140/80 mmHg) and the management of type 2 diabetes cholesterol (≤5 mmol/L) indicators in primary care to bring a range of in the financial year 2010‐2011, as benefits, including improved health well as the number of National outcomes—such as a reduction in Diabetes Audit processes completed the risk of STDR—for people with in 2010‐2011. The outcome was type 2 diabetes. time to incident STDR. Nearest
HOME & AWAY WHO CC INITIATIVES ON COVID-19 Since the start of the pandemic last year, WHO Collaborating Centre have been engaging in a wide range of activities with WHO, such as: • Being part of the technical advisory committee for COVID-19 • Being part of the supreme advisory committee for COVDI-19 in Iraq • Being part of the advisory committee for COVID in UAE As the Centre remit is Education and Training, over 20 educational webinars have been delivered through WHO CC on COVID-related topics, from surveillance and primary care services to mental health and self- care during the pandemic. All webinars can be accessed on our website. Additionally, the Centre has been collaborating with WHO Iraq, carrying out the assessment of the situation following the first wave. Plans were put in place for dealing with transmission issues, developing public health responses, restructuring public health laboratories, supporting segmentation of hospital, and changing the role of primary care. This task continues, as the pandemic evolves. Moreover, a Health systems resilience project in collaboration with the Arab Public Health Association (ArPHA) was initiated in the last few months. Since the onset of the COVID-19 crisis on public health, managing the ever-increasing number of patients admitted to hospitals and ICU units while maintaining health services at the regular pace Image by @rawpixel.com via freepik.com
proved to be difficult in many parts of the world. The first stage of research aims to develop and validate an assessment tool for health system resilience. This tool will be valuable for measuring health system resilience in countries, help identify and find ways to minimize critical gaps in health systems and improve their performance during and after any kind of shock on the healthcare system. COLLABORATION WITH CDC IN THE KINGDOM OF SAUDI ARABIA The collaboration with CDC, currently known as the Public Health Agency, in Saudi Arabia on the transformation of public health workforce in the Kingdom, which has been flourishing for nearly a year now. It involves all aspects of training for practitioners and the wider public health workforce. New criteria have been developed to ensure accurate assessment of the needed competencies in the field after a benchmarking and situational analysis has been done with multiple interviews with stakeholders. As part of this collaboration, WHO Collaborating Centre will deliver seven structured courses needed in the region, and a strategic and operational plan has been developed on how to successfully sustain the development for multiple years.
Five minutes with… Chido Cambarami Support Officer What does your role involve and what do you enjoy about it? My role is WHO Support Officer for the Collaborating Centre team. It involves but is not limited to: Assisting my Project manager and the WHO CC Team with materials needed to execute projects. Helping with the documentation of various phases of projects. Liaising WHO CC and Public Health department as well as various organizations, facilitating communications and keeping appropriate parties updated on project developments. Conducting research and the gathering of key information for use in upcoming projects. Managing online communications, from social media, email and our website sources. PCPH/WHO CC provides the essentials skills and knowledge needed for my career progression. What do you enjoy most about your role? Though my role is under the umbrella of Support Officer, I liken it to ‘Dora the explorer’. With every present day, I’m faced with new possibilities, new tasks, projects and adventures. Climbing up any mountain is no easy task but having the team to climb alongside me echoes a song of perseverance whenever I feel discouraged or overwhelmed. Climbing the mountain is what I enjoy, embracing the challenges and taking on the new unchartered grounds. What were you doing prior to this? I was a Wellness Coach for ‘Solutions4Health’. My work included Smoking Cessation Support, Healthy Weight Management Programmes, Falls Prevention and NHS Health Checks. What are your outside interests and who are you outside of work? Outside of work, I thoroughly enjoy Flag worship dance, travelling, cooking and watching MasterChef. My place of origin is Zimbabwe, located in the southern hemisphere of Africa. I have been living in the United Kingdom for over 15 years. I love food and have a keen interest in learning cooking styles and recipes from various nations.
What are your goals for the next few years? In the next few years, I will be a multi-business owner. I became interested in Public Health due to my concern in the increase of Childhood Obesity so as a result I aim to have healthy food chains across the world. What 3 tunes and luxury item would you choose to be marooned on a desert island with? My three tunes would include: Bryan & Katie Torwalt - Holy Spirit Michael W.Smith - Agnus Dei DappyTKeys - 8 Hour Relaxation sleep music Luxury item: Holy Bible Image: @bedneyimages via freepik.com
Would you like to have students to help with your Covid vaccination delivery? If you have opportunities that medical students could assist you with we would be happy to signpost students across all years to help with your vaccination programme – this could be either within your practice or at a local vaccination hub that you attend. If you are interested in/have a need for this please provide some basic details about the roles (see below) to the Primary Care Faculty Development Manager, Nadine Engineer, and we will include your opportunity on our online noticeboard - students can then contact you direct if they are able to help: • Role location • Roles available e.g. ushering, registration, making phone calls, giving vaccinations etc • Training requirements • Payment (if applicable) & approx. hours • Contact person for students to liaise with Students and tutors are asked to ensure that involvement does not interfere with MBBS studies
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