Japan announced today that they are moving forward with plans to vaccinate medical staff and quarantine officials with their stockpiled pre-pandemic vaccine against H5N1.
Japan plans to vaccinate 6,000 medical workers and quarantine officers with stockpiled bird flu vaccines to check their effectiveness and possible side-effects, the health ministry said on Tuesday.
The plan, which follows suggestions made by some lawmakers and experts that vaccinations take place before a feared flu pandemic, will be submitted to a panel of experts for approval on Wednesday, an official said.
If approved, vaccination will take place before the end of the fiscal year in March 2009, and mark the first case in the world in which the vaccines -- based on strains of the H5N1 virus from China and Indonesia -- have been given to such a large group of people prior to a possible pandemic.
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I have been a proponent of pre-pandemic vaccination of as many Health Care Providers, First Responders, and critical infrastructure personnel as possible for about as long as the concept has been floating around. I do always caveat that support though with the stipulation that the vaccine not contain any adjuvant, as I believe they are an unnecessarily dangerous inclusion for healthy younger adult, a wild card that even I am not willing to gamble on.
By protecting the Front Line we protect the maximum number of those who will need them to be on post should the pandemic happen. The currently unanswerable question is just how much protection will be afforded to those who receive the pre-pandemic strain of vaccine.
Under normal circumstances vaccines are meant to convey immunity to a disease. Unfortunately it is the current assumption that vaccination with a mismatched strain of H5N1 will not convey immunity. So, with the stockpiled pre-pandemic vaccines the bar has been considerably lowered; it is simply hoped that it will greatly reduce the severity of illness in those that receive it, full immunity being viewed as unattainable.
No one assumes that the virus that attains the means to transmit from human-to-human [H2H] will be the same strain [closely matched on a genetic and/or amino acid level] as the stockpiled vaccine. Since influenza undergoes rapid changes, and H5N1 is demonstrating a propensity for regional specificity, there is a strong possibility the strain used for the vaccine will be significantly different than the eventual (should it be eventual) pandemic strain.
The level of protection will be measured by the amount of antibodies that those who receive it produce. Unfortunately, with the human H5N1 vaccines approved thus far there has been a discouraging weak immune response, which is why those who are in development and production, as well as those in procurement, are eying the adjuvants so strongly.
The pre-pandemic vaccine is a gamble. It's a gamble to stockpile a potentially useless vaccine. It's a gamble to give it before a pandemic presents itself, after all, the next pandemic may never happen, or it may not happen for any number of years, or even a decade or two, and the antibodies produced from vaccine wane with each passing month. It's a gamble that there will be no adverse reactions for a percentage of those receiving the vaccine, a risk that goes up as the number of recipients goes up.
Will Japan's gamble pay off? Almost certainly if a pandemic happens in the next year or three. In and of itself that makes the gamble worthwhile. Japan's existing policy is to vaccinate when the World Health Organization (WHO) raises the pandemic alert level from 3 (current) to 4. Should the proposed plan be approved the initial administration will happen while the world is still in pandemic threat level 3. Further, should the plan go forward Japan will be the first nation in the world to do so. Will others follow? I can only hope, since time may well not be on our side. It takes boldness to be the first, it takes decidedly less to follow a sound and reasoned example.
I applaud Japan's Health Ministry for the bold initiative to protect those who will be on the forefront of an outbreak. Since it takes roughly a month for the body's production of antibodies against influenza to be meaningful pre-administering the vaccine has a huge timing benefit. Those on the front lines will not have to wait, or be needlessly unprotected, even though this is an admittedly a probable nominal level of protection.
I think of the level of protection along the lines of the bullet-proof vest my son dons prior to every patrol shift. While the vest does not offer 100% protection against a bullet, it is far better than nothing, and it greatly reduces his odds of being the recipient of a fatal gunshot wound. And, let's be honest here: when we are talking life-and-death, it's the "fatal" part that carries the most weight.
Whether a wound or illness it's easier to stand on that ever so important to society Front Line if those standing know that recovery is the most likely outcome should the protection they have been issued (vest or vaccine) prove to be less than that Golden One Hundred Percent.
Sometimes in life "recovery" is the best we can hope for because prevention is beyond the moment's reality. With this gamble Japan is not only grasping its best current hope for the individual, but also for the nation as a whole, that it will be recovery, and not a fatal blow, that is faced should a severe pandemic happen anytime in the near term.