Original text of the second edition of the vaccination guide

The unified requirement to universally strengthen vaccination for the entire population is cancelled, and the priority of services is tilted towards three types of high-risk groups: the elderly group over 60 years old, the group with serious underlying diseases, and the immunocompromised group. The vaccination interval is adjusted to 6 months after infection or the previous dose of vaccination (the immunocompromised group can be shortened to 3 months).

I happened to be doing research on the implementation of the vaccination strategy at a community health service center in Jiangsu and Zhejiang. On the day when the document came out, Director Wang at the vaccination site breathed a sigh of relief and said that in order to increase the vaccination rate for the whole population, he had been calling students from the local colleges and universities every day to persuade them to vaccinate. They were very annoyed. Now he can finally free up his energy to vaccinate the elderly people in the community who have trouble going out.

The definition of the target group in the original guideline is actually very clear: First, people who are not infected and have not completed basic immunization are recommended to complete basic vaccination first, regardless of age restrictions.； Second, regardless of whether you have been infected or not, as long as you belong to the above three categories of high-risk groups and it has been 6 months since the last vaccination or infection, it is recommended to receive a booster shot. Last month I met a 78-year-old Aunt Zhang, who has a history of COPD. She had erectile dysfunction in December last year. She came for consultation in June this year. She calculated that the interval was just within the standard, and she was given a recombinant protein allogeneic vaccination. During the observation, she also said that she was always afraid that the vaccination would induce asthma and suffocation. As a result, there were no adverse reactions. Now she feels much more confident when going to square dance.

However, there are also different voices in the academic circle regarding adjustments to this version of the guidelines. Most scholars who do research on epidemiological models are supportive. Calculation data previously released by the School of Public Health of Peking University shows that the coverage rate of mixed immunity (infection + vaccination) for the entire domestic population before the release of the guidelines has exceeded 85%. The marginal benefit of universal vaccination of healthy young and middle-aged people with booster shots is extremely low. Instead, it may be affected by the immune imprinting effect and weaken the immune system's ability to respond to new mutant strains in the future. This adjustment can be regarded as a wise use of resources. However, some frontline clinical experts have put forward different views. For example, the team from the Peking Union Medical College Respiratory Medicine Department mentioned that currently, people aged 60-79 without serious underlying diseases often mistakenly believe that they are not at high risk. However, in fact, their risk of severe illness after infection with the new mutant strain is still 3-5 times that of healthy young people. The guideline does not clearly include this group of people in the recommended vaccination range, which is somewhat regrettable and can easily lead to cognitive loopholes. The data we surveyed can also confirm this issue: in the three months after the release of the guideline, the vaccination rate for the elderly over 80 years old in the three responsible communities increased from 37% to 63%. However, for the group aged 60-79 suffering from hypertension and diabetes, the vaccination rate only increased by less than 5%.

In fact, vaccination is a bit like carrying an umbrella on a rainy day: it’s usually sunny every day, but you force everyone to have an umbrella, and everyone doesn’t use it because it’s too heavy.； But for people who are prone to catching colds in the rain, it is really useful if you take the initiative to hand the umbrella to them. To put it bluntly, this version of the guide changes the previous logic of forcing umbrellas into giving umbrellas to those who need them.

When I usually explain to relatives and friends, I don’t copy the provisions. I just ask three questions: Is it over 60 years old? Do you have any underlying diseases such as diabetes, COPD, or renal insufficiency? Have you been taking immunosuppressants for a long time, or have you had an organ or hematopoietic stem cell transplant? If you have any one of them, as long as it’s been more than half a year since your last infection or vaccination, get vaccinated ； If you are in your 30s and are in good health and have had two erections, there is really no need to go to a vaccination site. Of course, if you are worried, it is perfectly fine to want to get vaccinated. The guidelines have never restricted the vaccination needs of healthy people.

When I was flipping through the documents a few days ago, I saw that the appendix of this version of the guide specifically includes a list of suitable groups for vaccines with different technical routes. In the past, many people were confused about whether to use inactivated, recombinant protein or adenoviral vectors. Now they can just check the table directly, without listening to the messy rumors on the Internet. In the final analysis, guides are dead and people are alive. Making choices based on your own physical condition is the safest.