US Pandemic Vaccine Supply
It has been awhile since I addressed anything specifically on influenza pandemic vaccines so I will restate my long held adamant belief and support of the development and stockpiling of pre-pandemic H5N1 vaccines. To be sure, pandemic vaccine, pre-pandemic or otherwise, is a complicated issue.
One need only review Maryn McKenna's seven part series for CIDRAP The Pandemic Vaccine Puzzle to glimpse the seemingly intractable complications (at least in the shorter term) and the difficult choices and decisions required.
Thursday US Health and Human Services (HHS) announced that their stockpile of H5N1 pre-pandemic vaccine supply currently stands at enough to immunize 13 million people. Unfortunately the US has a current population estimated at somewhere around 303 million people. That figures out to be roughly four percent of the population.
From CIDRAP:
Mar 20, 2008 (CIDRAP News) – A progress report released today says the US government has stockpiled enough prepandemic H5N1 influenza vaccine for 13 million people, more than double the number listed in the previous report, issued last July.
The United States is a large and prosperous country (when measured against the average). We are now in our eleventh year of facing the potential threat of a human pandemic from H5N1. Even if I choose to be generous and only count backward in time to when H5N1 began its forays into human infections with an ever forward and outward march around the globe to 2003 we are still five years on. After five years to only have four percent of our population covered by a pre-pandemic vaccine is not only sad, in my opinion, but pathetically so.
The report on pandemic preparations by the Department of Health and Human Services (HHS) also says the government plans to release a new version of its pandemic vaccine allocation plan in coming months, after considering comments at a series of recent meetings and forums.
The last (draft) version of the vaccine allocation guidance document can be found here.
As the allocation stands currently we are still 10 million shy of tier 1 qualified recipients. Those 10 million, according to these guidelines, would be the Infants/toddlers.
I anticipate changes to the above categories, a swapping of tiers for certain segments of the population. There are just far more who need to be protected than there is protection at this point, and to move a segment into Tier 1 priority means moving another segment out and farther down the priority line.
Tough choices. However tough it may be it is still something that has to be decided. And it has to be decided because we as a country, our leaders, and those who have been appointed by those leaders have failed to act with vision and boldness in the face of a potential severe influenza pandemic.
The 16-page report from HHS Secretary Mike Leavitt lists a wide range of HHS pandemic preparations. It emphasizes the agency's efforts to collaborate with other stakeholders in tackling problems like vaccine allocation and who should bear the burden of stockpiling supplies such as face masks, respirators, and antiviral drugs. The report is the fifth in a series that began in March 2006.
Concerning the H5N1 vaccine, the report says, "By the end of 2007, HHS had purchased and stockpiled 13 million courses of pre-pandemic vaccine." The previous report, issued in mid-July, said the agency had acquired 12 million doses of the vaccine, enough for 6 million people.
The vaccine, based on a clade 1 virus isolated from a Vietnamese patient in 2004, was approved by the Food and Drug Administration in April 2007. Although no one knows how well it would work against an emerging pandemic strain of H5N1, HHS officials hope it would provide some protection to those most at risk for exposure in the early months of a pandemic.
And there is the Cosmic Joke (or insult). Even though I am a staunch supporter of the pre-pandemic vaccine program, yes, even given the Swine Flu debacle of the '70s, the pre-pandemic vaccine may only provide the barest minimum of protection against H5N1. By "barest minimum" I mean that it is likely to keep most people from having a fatal infection, but they will still have a high probability of getting sick, some even severely so. Severe or no, recovery beats dead any day.
Additionally, if we encourage our critical front line personnel, Tier 1 folk, to also get the pneumonia vaccine (guards against bacterial pneumonia but not viral pneumonia), we will go a long way in avoiding the "severely ill" side of the potentials of being vaccinated with a far less than optimal pre-pandemic influenza vaccine – or so it is reasonably assumed given current understanding.
If it is safe to assume that the pre-pandemic vaccine for H5N1 that we do have will not protect most from getting ill from H5N1 while they perform their critical duties what about those workers bringing H5N1 into their homes, exposing their unprotected family members?
My son is a police officer, a "street cop", for a small city. As such he is in Tier 1 for vaccine priority as it stands currently. But honestly, knowing what I know about the vaccine, I shudder at the thought of him bringing infection home to his wife and (currently) one year old daughter, both of whom will be without even the minimal protection offered by the vaccine because there just aren't enough of them.
And what causes my shudders will be faced by all of those who receive this scarce vaccine. By not having enough we have reduced its benefit even further.
It is my belief that we have squandered valuable time and in so doing have potentially squandered human life. Fortunately, sometimes, we are afforded the opportunity to remedy our mistakes.
I take comfort in knowing that the vaccine issue is being attacked on any number of fronts, and perhaps, just perhaps, we will have all the time needed to overcome the difficulties and shortfalls.
One can only hope anyway.
SZ
Comments