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  • Scarce pandemic vaccine - First to receive....

    In the early weeks of a flu pandemic, the first to receive scarce supplies of vaccine will include the military, medical and emergency workers, pregnant women and babies ? nearly 23 million people ? under a draft federal plan to be outlined Tuesday in Washington.

    At the back of the pack, in a pandemic of the sort that killed 20 million Americans in 1918, would be 74 million sick and elderly adults and 122 million healthy people ages 19-64.

    The plan was developed by a government working group that met with scientists and business and community representatives over several months. It provides guidelines for pandemic planners and offers a glimpse into some agonizing decisions that could be necessary in the context of a swift-moving infectious disease and a shortage of protective vaccine.

    "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," says William Raub, science adviser to Health and Human Services Secretary Michael Leavitt.

    "The committee tried to identify those who would be critical to national and homeland security, critical to fighting the flu itself, and critical to maintaining a functioning society."


    In meetings, the working group and other participants highlighted pregnant women and children as a priority, the report says. This also is an efficient use of vaccine, it says, because immunizing pregnant women protects their newborns, too, and children need lower doses, stretching limited supplies.

    Jeffrey Levi of Trust for America's Health, an advocacy group, says the report, being presented at a meeting of the National Vaccine Advisory Committee, is "logical," but more discussion is needed to refine how vaccine will be distributed and used in different populations.

    The plan provides for changes based on local needs and severity. In mild pandemics, which cause fewer deaths among the young and healthy, it makes sense to move those at risk of serious illness, such as the elderly and people with chronic illnesses, higher on the list, Raub says.

    For instance, the plan doesn't target such groups as banking, food and agriculture, postal or chemical workers in a mild or moderate pandemic. But in a severe pandemic, those groups are in the third tier for vaccination, just behind electricity, natural gas, communications and water personnel and essential government workers.

    "The more severe the pandemic, the more aggressive people would be in trying to protect critical workers," Raub says. "But if it's at the milder end, critical workers would be a smaller group, so there would be more emphasis on getting everyone vaccinated. The disruption of society wouldn't be the same."

    A pandemic occurs when a new flu virus emerges that can spread as easily as the seasonal flu, which causes 200,000 hospitalizations and 36,000 deaths each year. Because it's different from known flu viruses, people have no built-in immunity, so everyone is at risk.

    Planning for the next possible pandemic moved into high gear when a new flu strain, H5N1, also known as bird flu, emerged 10 years ago and began causing illness and death in humans. The World Health Organization warned then that the world could be "on the brink" of the next pandemic. Since 2003, WHO has documented 331 human cases, including 203 deaths from the virus, most of them in Southeast Asia.

    "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

  • #2
    Re: Scarce pandemic vaccine to be given in order

    "At the back of the pack, in a pandemic of the sort that killed 20 million Americans in 1918, would be 74 million sick and elderly adults and 122 million healthy people ages 19-64."
    _____
    Without pandemic vaccines?
    Then give an PRE-pandemic vaccine in advance!
    Why stay without some PRE-pandemic multistrain vaccines, the only thing that can give some differents in time, maybe.
    We agree that we don't know the future pandemic main strain, but it's better to thrown the wrong vaccine than have a priory no chance at all.

    Why those various "triage for others, not me" working groups will not concieve a kind of plan that include all citizens?

    Why not start now to build more new vaccine factories, and
    why not start to produce PRE-pandemic (cell, or not) vaccines based on the strains we have now - and put the costs on "the others"- individual private payments - in advance?
    If a state don't want to store PRE-pandemic vaccine for ALL citizens, why not give a chance to buy privately (through the official distribution system) an PRE-pandemic vaccine?

    The minimum necessary will be to create lists of citizens who will not got the vaccine, and than inform them by letter that they can got the (cell, or other) pre-pandemic vaccine in a case of an pandemic, if they agree by signed letter to individualy pay in advance the costs of the individual doses (named it, stored it at the town level, or at home, to use only in the pandemic flu event)!
    Who don't won't to agree, will loose this oportunity and wait to got the pandemic vaccine only.

    A little price individualy, but a relief for the summing price at the state/world level.
    Why not?

    Are we taxpayers? Then we must have the access to the PRE-pandemic vaccines like we have for other registered medicines!

    The PRE-pandemic vaccines must be reached (in a regular way) privately prior the pandemic starts from the ones who will not get the pandemic vaccine because of the priority lists!

    ___
    "The plan was developed by a government working group that met with scientists and business and community representatives over several months. It provides guidelines for pandemic planners and offers a glimpse into some agonizing decisions that could be necessary in the context of a swift-moving infectious disease and a shortage of protective vaccine.
    "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," says William Raub, science adviser to Health and Human Services Secretary Michael Leavitt."

    Comment


    • #3
      Troops, key doctors to get first U.S. bird flu shots

      pending revisions based on general population comment...general population being last in line with the current draft.

      Troops, key doctors to get first U.S. bird flu shots


      By Maggie Fox, Health and Science Editor 2 hours, 49 minutes ago

      WASHINGTON (Reuters) - Deployed military troops, emergency workers, pregnant women and children will be among the first to get scarce vaccinations if a pandemic strain of flu breaks out, U.S. officials said.
      A long-awaited report to be issued on Tuesday lays out who would be first in line to get vaccinated against H5N1 bird flu or any other strain of pandemic influenza.

      The Health and Human Services report proposes creating four categories of people, and vaccinating the top tier of each category first. The categories are homeland and national security critical infrastructure, health and community support services and the general population.,

      "Certain military personnel like deployed forces would get vaccinated before certain other military personnel," HHS science adviser William Raub said in a telephone interview.

      Virtually all health experts agree that the world is overdue for a pandemic of some sort of influenza.

      No one can predict when one might come, how bad it would be or which strain of influenza virus may be responsible. But the H5N1 bird flu virus that has infected 331 people since 2003, killing 203 of them, is the current chief candidate.

      Companies are working to make a vaccine against H5N1 but the process takes months and it is not clear if vaccines formulated to match the current strain would protect well against whatever mutated version emerges to cause a pandemic.

      "We won't be able to start making a true vaccine against the actual pandemic virus until that virus appears, until we have samples," Raub said.

      "No matter how rapidly we build up our production capacity we won't have 300 million doses of vaccine overnight. The material will come off the line in successive lots.

      "So therefore it means we need to have in hand a well-thought-out, transparent framework as to how we hope states and communities would make the decision about who gets vaccinated first."

      REVISIONS PENDING

      The plan, to be released at public meetings and on the Internet at http://pandemicflu.gov, is not final and will be revised after comments from experts and members of the general public, Raub said.

      Much depends on how severe the pandemic actually is. The 1918 pandemic killed hundreds of millions of people globally, but two others, in 1957 and 1968, were much milder.

      Raub said it also is not clear if people who are vaccinated with the so-called pre-pandemic vaccines being prepared now should go to the back of the line.

      Level "A" people to get vaccinated first include "deployed and mission-critical personnel" under the homeland and national security category. Level A in the critical infrastructure category include emergency medical services workers, law enforcement and fire personnel, flu vaccine and drug makers and key government leaders.

      Under health, those first in line include public health and direct health care providers, while under the general public category, pregnant women and infants and toddlers come first.

      "In past pandemics, groups at increased risk for serious illness and death have differed by age and health status," the report reads.

      "Because the high-risk groups in the next pandemic are not known, this guidance will be reassessed and may be modified at the time of the pandemic."

      Comment


      • #4
        Re: Scarce pandemic vaccine - First to receive....

        "We won't be able to start making a true vaccine against the actual pandemic virus until that virus appears, until we have samples," Raub said.
        "No matter how rapidly we build up our production capacity we won't have 300 million doses of vaccine overnight. The material will come off the line in successive lots.
        _____

        Obviously because nobody know "when" a pandemic will happen (1-5 years?), the world nations have maybe plenty of times to create the enaugh production capacity sites through over the world (not overnight).
        If the vaccine will be produced in these sites with "cell" technology, than it can be produced "in enaugh real time", maybe.

        Other possibilities will exists, also. From an news from FluWiki yesterday:
        ... In partnership with foreign scientific centres,
        ... launch(ed) a large-scale work to create a universal vaccine against highly pathogenic viral infections, including bird flu"...
        _____

        Raub said it also is not clear if people who are vaccinated with the so-called pre-pandemic vaccines being prepared now should go to the back of the line.

        If the pre-pandemic vaccine from the 3 known potential pandemic strains (for the seasonal flu is the same way of picking the strains, 1 year in advance, NOT when a flu epidemic strike) will be produced for ALL citizens, stored, and distributed at the start of the pandemic, than this question will not be posed.

        _____
        Reference from "FluWiki":


        Bird flu remains real threat for world and Russia - specialists
        22.10.2007, 11.39
        http://www.itar-tass...
        ST. PETERSBURG, October 22 (Itar-Tass) - Bird flu "remains a real threat for the humankind and for Russia, in particular," specialists from the St. Petersburg-based National Centre for Influenza of the World Health Organization said on Monday.
        The head of the centre, Academician Oleg Kiselyov, stressed that the possibility of "a bird flu pandemic on the global scope persists". This is not a corporative point of view of epidemiologists, Kiselyov specified. According to WHO forecasts, at the present stage "the world finds itself in the third stage of a pre-epidemic period, while all in all there are sixth such stages," he said. The present stage is characterized by sporadic cases in which bird flu is passed between humans, he noted.
        He said "According to the WHO, the total number of confirmed H5N1 cases among humans has reached 356, of which 210 cases were lethal". The biggest number of bird flu victims was registered in Indonesia, where 86 people were killed.
        It is a matter of vital necessity "to unite efforts of European, American, British and Russian scientists, colleagues from other countries to monitor, study, prevent and treat flu in order to raise the level of readiness for a flu pandemic," he stressed.
        Within the framework of a European project for fight against highly pathogenic viruses, the scientific-and-research institute for influenza of the Russian Academy of Sciences in St. Petersburg is taking adequate preventive measures, he reported.
        In partnership with foreign scientific centres, "we have launched large-scale work to create a universal vaccine against highly pathogenic viral infections, including bird flu," Kiselyov said.
        Concrete results are expected in five years, he added. Earlier, the Petersburg institute created and tested a vaccine against the H5N1 strain of bird flu, which will be used in case of an epidemic.



        <HR align=left width="50%">
        by: Pixie @ Mon Oct 22, 2007 at 05:11:54 AM CDT

        Comment


        • #5
          Re: Scarce pandemic vaccine - First to receive....

          Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine

          ContentIntroduction

          Effective allocation of vaccines will play a critical role in preventing influenza and reducing its effects on health and society when a pandemic arrives. The specific type of influenza that causes a pandemic will not be known until it occurs. Developing a new vaccine in response will take several months and pandemic vaccine may not be available when cases first occur in the United States. Moreover, once vaccine production begins, it will not be possible to make enough new vaccine to protect everyone in the early stages of a pandemic.

          The U.S. Government is taking steps to minimize the need to make vaccine allocation decisions by supporting efforts to increase domestic influenza vaccine production capacity. Significant funding is being provided to develop new vaccine technologies that allow production of enough pandemic influenza vaccine for any person in the United States who wants to be vaccinated within six months of a pandemic declaration. Until this goal is met, Federal, State, local and tribal governments, communities, and the private sector will need guidance on who should be vaccinated earlier during the pandemic to best protect our people, communities, and country.

          **snipped** Full access below




          Website: http://www.pandemicflu.gov/vaccine/prioritization.html

          pdf prioritization.pdf
          "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

          Comment


          • #6
            Re: Scarce pandemic vaccine - First to receive....

            Public weighs in on pandemic vaccine allocation plan


            Lisa Schnirring Staff Writer

            Dec 12, 2007 (CIDRAP News) ? As US officials wrap up efforts to gauge the public's response to a draft plan for allocating vaccine supplies during an influenza pandemic, suggestions to fine-tune the plan are emerging, such as giving higher priority to critical infrastructure workers, the families of key healthcare workers, and community pharmacists.

            A 3-day Web dialogue, held Dec 4 through 6, drew about 420 people who either participated in or observed guided discussions on various aspects of the pandemic vaccine prioritization draft, according to summaries of the dialogue posted on the event Web site. The event was sponsored by the US Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), along with the Association of State and Territorial Health Officials (ASTHO) and National Association of County and City Health Officials (NACCHO).

            The groups, with assistance from the Keystone Center, a nonprofit science public policy group based in Keystone, Colo., will hold a stakeholder meeting in Washington, DC, tomorrow. They also sponsored a series of public engagement meetings in January in Las Cruces, N.M., and Nassau County, N.Y., and in November in Milwaukee and Henderson County, N.C. HHS is taking comments on the draft pandemic vaccine allocation plan through Dec 31, according to a Federal Register notice.

            A federal interagency working group presented its vaccine prioritization draft to HHS's National Vaccine Advisory Committee on Oct 23. The tiered approach lists key health and safety personnel and children as top priorities.

            During the Web dialogue, participants offered several ideas for revising the draft guidance, according to daily summaries on the dialogue Web site. Some suggested that adding an age criterion to the occupation groups might help the plan fulfill its goals of reducing deaths and maintaining critical infrastructure. "It was noted that the draft guidance is not age-based, but leans more toward protecting society (critical infrastructure) and the population groups at the top [of the priority lists]," the summary notes.

            One of the main themes, according to the daily summaries, was protecting critical infrastructure, especially the electric power grid. Employees who maintain electrical systems should be moved to the top tier, many of the participants said.

            "Some suggested that the only true critical infrastructure is electric power," the dialogue summary said. Employees that maintain power systems "should receive the highest priority for prophylactic antiviral medications, have special support for their families, and be first in line for vaccine," the summary noted.

            The vaccination priority of family members was also raised several other times during the Web dialogue. Though many participants seemed to support family coverage for first responders and other key healthcare workers, there was less of a consensus on priority status for the families of military members and homeland security employees. Some surveys have indicated that many healthcare workers will not show up for work during a pandemic if their families don't receive antiviral medication or vaccines and if they don't have adequate personal protective equipment.


            Some participants said the final vaccine priority plan should factor in important supply chain issues and protect workers who produce and deliver necessities such as raw materials, medicine, food, and fuel.

            The discussion moderators asked participants what the government should do to make the vaccine priority plan more acceptable to the public.
            Suggestions included keeping citizens informed when supplies of vaccines and antiviral medications change. "Citizens will be enraged if their expectation is not adjusted before a pandemic starts. Set the policy for the current reality and be up-front about the implications," the summary said.

            Though the discussion summaries don't suggest that participants supported moving many groups down on the priority list, a poll at the end of the dialogue asked participants to make some difficult choices. The dialogue summary said the poll questions were crafted from questions and concerns from the dialogue and public engagement sessions. About 170 people took part in the poll, which also included some who attended public engagement sessions in Henderson County, N.C., and Milwaukee. The poll results are available on the dialogue Web site.

            For example, when participants were asked if people aged 80 or older should be moved from tier 4 to tier 5, 76% (129) agreed to some extent. And when they were asked if school-age children should be moved up and vaccinated before infants and younger children, 79% (135) agreed.

            Terry Adirim, MD, MPH, a member of the federal interagency work group that produced the draft vaccine plan, served as a panelist during all of the Web dialogue. Adirim is medical adviser for medical readiness in the Office of Health Affairs in the US Department of Homeland Security. She also helped facilitate some of the public engagement forums.

            Adirim said the dialogue and public engagement sessions were designed both to solicit public comments and to educate the public about pandemic readiness issues, and the facilitators were impressed with how much many of the attendees already knew about the topics. "We consider it a success," she said, adding that participants made it clear they had concerns about personal preparedness and government transparency about pandemic and vaccine-related issues.

            "People also wanted children protected, and moderators familiar with the vaccine plan were able to address why they [the interagency working group] did what they did," Adirim said.

            Nicholas Kelley, a masters' degree candidate in environmental public health at the University of Minnesota, took part in the dialogue during all three days. "I'm 24, so I'm in an age-group that would be at high risk, and these issues are fascinating to me," he said. Kelley is also a research assistant for the CIDRAP Business Source and has worked on college pandemic plans.
            He said many of the participants were uncertain about how the case-fatality rate during a pandemic will actually steer vaccination strategies, especially since what's known about the rates during a pandemic is based on historical data. "There's a lot of disconnect," Kelley said.

            "People really want to keep as many alive as possible, but no one really wanted to move people down [the priority list]," he said.

            Support for protecting critical infrastructure workers grew as the Web dialogue progressed, Kelley noted. "You could see a real shift by the third day. People were adamant about critical infrastructure," he said.

            "In a public forum, there are always possibilities for heated emotional exchanges, but the Web format included well-articulated and thought-out comments," Kelley said of the Web dialogue.

            In a previous report, the federal interagency working group said that after receiving public comments it would revise the vaccine prioritization plan, which will be considered a final interim report.

            See also:
            Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine


            Oct 24 CIDRAP News story "Pandemic vaccine proposal favors health workers, children"

            Federal Register notice on comment submission

            Pandemic vaccine prioritization Web dialogue site

            Pandemic vaccine allocation poll results
            "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

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