2021 Vaccination Guide

This is my country's first official guidance document for large-scale COVID-19 vaccination for the entire population. The core goal is to promote basic immunization for the entire population in a safe and orderly manner. It clearly narrows the contraindications to vaccination to five core categories. Targeting the original strain and Alpha mutant strain of COVID-19 that were prevalent at the time, the severe protection rate after full vaccination reaches more than 90%, and the overall infection protection rate is about 70%.

The first time I touched a paper printout of this guide was at the end of March 2021. At that time, I was sent by my employer to work as a volunteer at a community vaccination site in Chaoyang District, Beijing. On the day of registration, the stationmaster directly thrust the folded printout with fluffy edges into my hand, saying that I could memorize other things slowly. I must memorize these five contraindications by heart first, otherwise I would be unable to open my mouth with questions from the uncles and aunts who came to consult me all morning.

To be honest, everyone’s understanding of the COVID-19 vaccine was still very confusing at that time. One day there was a rumor that “diabetics must not take it”, and the next day there were rumors that “high blood pressure will cause stroke”. This version of the guideline is equivalent to directly drawing the clearest line for everyone - as long as it is not about the active/inactive status of the vaccine. Those who are severely allergic to ingredients and production materials, have had acute allergic reactions, angioedema and other serious reactions to vaccines in the past, have uncontrolled severe neurological diseases, are in the stage of fever/acute disease attack, uncontrolled chronic disease, and are pregnant. In other cases, you can get the vaccine without worrying about it. I was particularly impressed. At that time, there was an uncle Zhang who had been suffering from type 2 diabetes for 12 years. He squatted at the door of the vaccination site for three days with a thick stack of medical records, fearing that there would be a problem with the injection. I read him the instructions on chronic diseases in the guide, and asked the on-site general practitioner to read his blood sugar monitoring records for the past three months. His fasting has been stable between 6.8 and 7.5. Finally, he got the first injection smoothly. After observing for half an hour, nothing happened. He even brought his wife who was doing square dancing with him for the second injection.

Of course, practitioners in different lines actually had different judgments on the implementation standards of this version of the Guidelines at that time. For example, colleagues in charge of epidemic control will be under great pressure. Guangzhou has just ended a local epidemic of the Alpha mutant strain, and the risk of exposure for port and cold chain employees is extremely high. Their view is that as long as it is not within the scope of clearly listed contraindications, we should do our best to fight the epidemic. If we establish a barrier a day earlier, we will reduce the risk of an outbreak. However, clinicians at the vaccination site will be more conservative. I have met several patients with hyperthyroidism who came for vaccination. Their indicators had fluctuated for less than a week. Even if they said they were not feeling uncomfortable, the doctors would advise them to wait for two weeks for re-examination when the indicators were stable. This is not a violation of the guidelines, but because everyone is afraid of adverse reactions, which will discourage everyone from getting vaccinated. Both judgments are actually correct, and they are both the best choices for their own positions.

The vaccination priorities set in the guidelines are also quite interesting. The first to be liberalized are practitioners in high-risk positions such as ports, cold chain, and medical care. My brother was doing customs inspection at the Capital Airport and received a pilot vaccine in January 2021. After the guidelines were officially released in March, the general population between 18 and 59 years old was gradually liberalized. In May, a supplementary notice was issued to further relax the vaccination threshold for people over 60 years old. As long as the underlying diseases are stable, they can be vaccinated. My mother had been taking medicine for high blood pressure for five or six years at that time, and her blood pressure had been stable at 130/80. She was afraid of not getting vaccinated before. After seeing the supplementary notice, she took the old sisters in the community to queue up the next day.

During the half month I stayed at the site, I privately compiled a few reminders that were not included in the guide. They were all summed up after being asked hundreds of times - don't drink heavily the day before vaccination, and don't stay up until two or three o'clock. If you have underlying diseases, you should bring your recent physical examination report, or simply put the medicine you take in your pocket, so as to avoid being unable to answer when the doctor asks you what medicine you have taken recently and whether your indicators are stable, and it will be a waste of time. If your arm is a little sore or you have a low fever after the injection, as long as it does not exceed 38.5 degrees and gradually subsides over 24 hours, there is no need to panic. These are normal adverse reactions. At that time, I had to explain to people dozens of times a day.

Surveillance data for the second half of 2021 released by the National Center for Disease Control and Prevention also verified the effectiveness of this version of the guideline. For people who have completed basic immunization, the severe disease rate after infection with the original strain and Alpha strain is 92% lower than that of unvaccinated people, and the mortality rate is more than 95% lower. Of course, there were different voices. At that time, some immunology experts suggested that the guidelines were not detailed enough for vaccination guidance for people with immune deficiencies and those during radiotherapy and chemotherapy for malignant tumors. At that time, there was little clinical data accumulation for these groups, and blind vaccination may be risky. Later, the guideline revision at the end of the year did supplement this part of the content.

Looking back now, this version of the 2021 vaccination guide is actually the product of a special period. It is not that perfect, and many details were completed step by step later. But at that time when everyone was confused about the direction, it was the most useful yardstick. I still have a photo of the crumpled printed copy of the guide I took at that time on my phone. The margins are filled with notes on the questions that people asked the most at that time. When I look through it now, I still remember the long queues at the vaccination site. Everyone was wearing a mask, and they were looking forward to getting the shot quickly and life returning to normal soon.