Core Viewpoint - The article discusses the extension of the graded referral model from disease treatment to disease prevention, emphasizing the role of clinical doctors in improving vaccine coverage among vulnerable populations and rebuilding trust in immunization [3]. Group 1: Vaccine Prescription and Assessment Clinics - The National Center for Disease Control and Prevention has recently supported the concept of "vaccine prescriptions," marking the first time this has been included in a policy document [3]. - Various regions, including Beijing, Shanghai, Guangdong, and Jiangsu, have initiated special assessment clinics for vulnerable populations to integrate clinical diagnosis with disease prevention [6][7]. - These assessment clinics primarily target children with special health conditions, providing medical vaccination advice and appropriate vaccine arrangements [6][7]. Group 2: Challenges in Vaccine Administration - There are significant challenges in the vaccine administration process, including the need for patients to undergo multiple consultations and tests before receiving vaccinations, which can deter them from proceeding [6][11]. - The lack of clinical guidelines for many diseases leads to hesitance among doctors to recommend vaccinations, as they fear potential legal repercussions from adverse reactions [10][11]. - The "first kilometer" and "last mile" issues highlight the logistical difficulties in the vaccine administration process, including the time and cost burdens on patients and the potential lack of recognition of assessment reports by community hospitals [11][12]. Group 3: Special Health Populations - Special health populations, such as children with cancer or organ transplant recipients, are at higher risk for severe outcomes from diseases like influenza, necessitating prioritized vaccination [9]. - The article notes that while some diseases are not listed as contraindications for vaccination, they also lack clear clinical treatment guidelines, complicating the decision-making process for healthcare providers [10]. - The need for multidisciplinary consultation platforms is emphasized to ensure comprehensive evaluations for patients with multiple health issues [11].

Core Viewpoint - The article discusses the challenges and developments in the vaccination process for vulnerable populations in China, highlighting the introduction of "vaccine prescriptions" and specialized assessment clinics to improve vaccination rates among high-risk groups [1][2][4]. Group 1: Vaccination Challenges - There is a prevalent avoidance mentality among doctors due to a lack of institutional support, which affects their willingness to recommend vaccinations [5][8]. - Vulnerable groups, such as infants, pregnant women, and immunocompromised patients, face higher risks of severe illness from influenza, yet vaccination rates remain low due to safety concerns from both healthcare providers and parents [1][4]. - The complexity of the vaccination process, including the need for multiple consultations and tests, discourages patients from seeking vaccinations [3][9]. Group 2: Vaccine Prescription and Assessment Clinics - The National Health Commission has recently supported the concept of "vaccine prescriptions," allowing clinical doctors to prescribe vaccines for suitable populations [1][2]. - Specialized assessment clinics have been established in various regions to provide tailored vaccination advice for individuals with special health conditions, focusing on the types and doses of vaccines appropriate for them [3][4]. - These clinics primarily serve children with specific health issues, such as cancer or autoimmune diseases, and aim to bridge the gap between clinical treatment and disease prevention [3][4]. Group 3: Implementation and Operational Issues - The implementation of vaccine prescriptions and assessment clinics is still in its early stages, with a shortage of qualified doctors capable of making informed vaccination decisions for special populations [6][8]. - The "first mile" and "last mile" challenges in the vaccination process involve significant time and cost burdens on patients, as well as potential skepticism from community healthcare providers regarding assessments made by higher-level hospitals [9][11]. - There is a need for multi-disciplinary consultation platforms to address the complexities of vaccination for patients with multiple health issues, although these can be costly and time-consuming [9][11].

Core Viewpoint - Vaccination is highlighted as one of the most cost-effective measures for preventing infectious diseases and their related complications, with a focus on integrating clinical treatment and disease prevention through vaccine prescriptions [1][2]. Group 1: Current Situation and Challenges - The elderly population in China has reached 310 million, leading to increased chronic disease prevalence and a heavier disease burden, making vaccine prescriptions a vital tool for connecting clinical care and disease prevention [1]. - The incidence of shingles among individuals over 50 is approximately 1.56 million cases annually, with diabetes patients having a 60% higher risk and those with cardiovascular diseases having a 39% higher risk compared to the general population [1]. - The hospitalization rate for shingles patients is 0.39%, with an average treatment cost of 8,116.9 yuan per hospitalization, leading to an estimated annual treatment expenditure of around 1.3 billion yuan for shingles in China [1]. - Despite the shingles vaccine being available for over five years, the vaccination rate among individuals over 50 remains below 1%, indicating that the value of vaccines has not been fully realized [1]. Group 2: Vaccine Prescription Implementation - Vaccine prescriptions consist of two levels: as a "health education prescription" for providing vaccination guidance to suitable populations, particularly chronic disease patients, and as an executable "medical prescription" allowing doctors to directly prescribe vaccines in certain pilot areas [2]. - The National Health Commission has officially supported vaccine prescriptions in policy documents, marking a significant step in promoting vaccination [2]. - Current pilot programs have shown positive progress, such as the establishment of vaccination clinics in some medical institutions, improving service accessibility and public acceptance [2]. - Challenges remain, including insufficient awareness among healthcare providers regarding vaccine prescriptions, incomplete incentive policies, and widespread vaccine hesitancy among the public [2]. Group 3: Recommendations for Improvement - To build a more comprehensive adult vaccination service system, it is recommended to encourage more secondary and tertiary hospitals to establish adult vaccination clinics to enhance accessibility and convenience [3]. - Strengthening policy support by incorporating vaccination performance into the evaluation system for healthcare institutions is suggested [3]. - Promoting interoperability of information systems to ensure efficient integration of clinical and preventive services is essential [3]. - The exploration of innovative technologies such as artificial intelligence and digital health to enhance public awareness and vaccination convenience is encouraged, along with continuous optimization of strategies through implementation research [3].