Using absolute risk reduction to guide the equitable distribution of COVID-19 vaccines

  1. Ella Fassler
  2. Andrew Larkin
  3. Kesavan Rajasekharan Nayar
  4. Howard Waitzkin

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Abstract

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  1. Version published to 10.1136/bmjebm-2021-111789
  2. ScreenIT

    SciScore for 10.1101/2021.06.28.21259039: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Systematic review: During April 2021 we searched PubMed for articles combining COVID and SARS-CoV-2 separately with each of the following terms: ARR, RRR, NNT, NNV, risk-benefit, and NNH.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    We also supplemented this search of the medical and public health literature by using a two general search engines, DuckDuckGo and Google, with the same search terms.
    Google
    suggested: (Google, RRID:SCR_017097)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations of study: Our findings based on limited data available led to concerns about the vaccines’ impact in reducing absolute risk below the baseline risks for pertinent population groups, as well as about the comparative benefits versus harms of the vaccines. From our calculations using data from two major RCTs and one population-based assessment, we concluded that the impact of the vaccines in reducing the risk of symptomatic infection below the baseline risk as measured by ARR is small, and the NNV to prevent one symptomatic infection is substantial. Measures of harm and comparisons of harms versus benefits by calculation of ARI and NNH are challenging to achieve with published data from these trials. The NNHs that we calculated were in a range comparable to the benefits of the vaccines as indicated by NNVs. While we were not able to resolve the question of benefits versus harms, our limited analysis revealed that they were not dramatically different and that the NNHs were low for some outcomes. Compared to prior vaccines such as influenza and smallpox, the efficacy of the COVID-19 vaccines in the RCTs and effectiveness in the population-based study appeared somewhat less impressive. Importantly, the sensitivity analysis of the vaccines’ benefits showed that the ARRs and NNVs are more favorable in areas with higher baseline rates of disease. This variability in effectiveness related to varying baseline risks leads to some possibly helpful policy recommen...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.06.28.21259039v1 on medRxiv