Scaling Up the Global COVID-19 Vaccination Program: Production, Allocation, and Distribution with an Emphasis on Equity.

After just over 2 years, the COVID-19 pandemic continues to contribute to extensive morbidity and mortality worldwide. In addition to the burden and loss caused by the virus itself, collateral consequences of the pandemic wreak havoc on the global economy, disrupt essential health care services and childhood education, and weaken existing mechanisms of preventing other infectious diseases such as HIV and tuberculosis (TB). These impacts are unequally felt in low- and middle-income countries due to an insufficient supply of COVID-19 vaccines and an unfair allocation process of distributing vaccines worldwide. An emphasis on equity throughout the continued scaling up of the global COVID-19 vaccination program with production, allocation, and distribution of COVID-19 vaccines could begin to mitigate the disparities in vaccinations seen across the world. Current policy solutions including COVAX, intellectual property waivers, technology transfer in South Africa, and dose donations are examined to evaluate efficacy in increasing equitable access to COVID-19 vaccines.

Fertility-sparing surgery and survival among reproductive-age women with epithelial ovarian cancer in 2 cancer registries.

BACKGROUND: This study examined predictors of fertility-sparing surgery (FSS) among reproductive-age women diagnosed with epithelial ovarian cancer (EOC). In addition, relationships between FSS and survival were assessed in models stratified by tumor characteristics. METHODS: The Surveillance, Epidemiology, and End Results (SEER) program and the National Cancer Database (NCDB) were queried for women 44 years old or younger with a primary EOC. FSS included unilateral salpingo-oophorectomy and uterine preservation, whereas surgeries including bilateral salpingo-oophorectomy and hysterectomy were categorized as non-FSS. Logistic regression was used to estimate multivariable-adjusted odds ratios and 95% confidence intervals (CIs) for associations between clinical characteristics (eg, age at diagnosis and race) and FSS odds. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% CIs for FSS and overall survival in subgroups defined by stage and grade or by stage and histology. Analyses were stratified by database (SEER vs NCDB). RESULTS: This analysis included 9017 women (SEER, n = 3932; NCDB, n = 5085) with EOC diagnosed between the ages of 15 and 44 years. In both cohorts, factors associated with significantly higher FSS odds included a younger age, a more recent ovarian cancer diagnosis, and no adjuvant chemotherapy. FSS was significantly associated with lower overall survival among women with stage II to IV, serous EOC (SEER HR, 1.61; 95% CI, 1.22-2.12). Significant associations between FSS and survival were not observed in other subgroups defined by stage and grade or by stage and histology. CONCLUSIONS: FSS appears to be safe for certain women with EOC but was related to poor survival among women with advanced-stage, serous EOC. Confirmatory studies with information on fertility intentions are needed.