Pandemic vaccine proposal favors health workers, children

Oct 24, 2007 (CIDRAP News) – A federal interagency working group yesterday released a draft report detailing how the government would allocate limited vaccine supplies if a severe influenza pandemic grips the United States, offering a tiered approach that flags key health and public safety personnel and children as top priorities.

The group presented the report to the Department of Health and Human Services (HHS) National Vaccine Advisory Committee and posted it on the agency's pandemic influenza Web site yesterday, along with a feedback tool for public comments. Today the group presented the report to the Center for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices.

"Once a pandemic starts, vaccine will come rolling off the line in lots, so there has to be a priority scheme on who would receive it first," said William Raub, science advisor to HHS Secretary Michael Leavitt, as quoted in in an Oct 22 USA Today report.

The report says the vaccine allocation plan is designed not only to save lives, but also to reduce the medical, social, and economic impacts of a pandemic. Vaccinations will be administered in tiers, which include four target groups: healthcare and community support services, critical infrastructure, homeland and national security, and the general population. For some of the target groups, the priority tier level would change depending on pandemic severity.

Prioritizations were based on the most recent scientific research on pandemics and vaccines and on meetings with the public and stakeholders. The working group also sought the input of ethicists, including from the National Institutes of Health and a group from the Minnesota Center for Healthcare Ethics (MCHCE), which published its own vaccine allocation recommendations in October 2006.

The highest-priority groups include deployed military and other critical national security personnel; emergency medical services, public safety workers, and key government officials; medical providers and public health workers; and pregnant women, infants, and toddlers.

"Children are not only highly susceptible to influenza, children are also very good at spreading it. Protecting them also protects those in the population," Raub said in an Oct 22 Associated Press report.

In adjusting priorities for different levels of pandemic severity, the rationing plan marks a shift from the federal pandemic plan released 2 years ago, which assumed a moderate pandemic.

Compared with the older plan, the new proposal changes the priorities for a number of groups. For example, the proposal puts elderly people and other high-risk adults in the fourth tier, whereas high-risk adults ranked second, right after medical and public health workers, in the older plan. Also, essential utility and communications workers are in the second tier 2 under the new plan, but ranked near the end of the line under the old one.

Dorothy Vawter, associate director of MCHCE, told CIDRAP News that the working group's recommendations represent a big step forward in pandemic planning. "They were willing to take on some tough issues, such as the age-based recommendations," she said.

"This is a great start to a communitywide conversation," Vawter said. She expects that some disagreements with the prioritizations will arise out of the public comments and will probably prompt the group to fine-tune the report.

Some people may be surprised to see the report's focus on social roles and responsibilities, and questions may be raised about the status of students and people who are unemployed, she said.

Vawter said one prioritization issue in the report that surprised her was a category in a lower tier that lumps young adults with health problems comorbidities in a group with people as old as 105. "There's no distinction in that tier, and it seems like too big of a bucket," she said, adding that it's likely the group will make some adjustments in that category.

Jeffrey Levi, director of Trust for America's Health, a healthcare advocacy group based in Washinton, DC, called the report "logical" but said more refinements are needed on vaccine distribution and use in different populations, according to the USA Today report.

The group said it will take public comments for 2 months and then revise the document, which will be considered a final interim report.

See also:

Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine
http://www.flu.gov/individualfamily/vaccination/allocationguidance.pdf

Oct 31, 2006, CIDRAP News story "Pandemic vaccine rationing proposal favors the young"

Nov 3, 2005, CIDRAP News story "Medical workers would get first pandemic flu shots"

HHS Pandemic Influenza Plan
http://www.hhs.gov/pandemicflu/plan/

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