Swine Flu Vaccine Priorities Outlined
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Anticipating that not enough swine flu [influenza pandemic (H1N1)
2009 virus] vaccine will be available to immunize every American in
time for the expected surge of cases this fall and winter, health
experts recommended on Wednesday [29 Jul 2009] that certain people
should be vaccinated 1st. The top priority group, 150 million
Americans in all, or about half the population, would include health
care workers and emergency medical responders, because their jobs are critical.
It would also include people with the highest risk of complications
and severe illness from the new H1N1 virus: pregnant women [see
above]; people caring for infants under 6 months; children and young
adults from 6 months to 24 years; and people aged 25 to 64 with
medical problems like asthma, diabetes or heart disease.
The recommendations were issued at a meeting of the Advisory
Committee on Immunization Practices (ACIP), a panel of medical
experts from around the country that advises the Centers for Disease
Control and Prevention. The group has 14 members who voted on the
recommendations, and the disease centers [CDC] usually take their
advice in issuing guidelines for state and local health officials.
But once the panel made its initial recommendation, members struggled
and argued about what to do if there was a severe shortage of the
vaccine and the eligibility requirements had to be drawn even
tighter. The deliberations left some shaking their heads in confusion
and dismay. As the meeting dragged on past its deadline, one member,
looking piqued, left before the final vote.
Ultimately, the group decided that if the shortage was severe,
healthy children over 4 would not be vaccinated, nor would any adults
except pregnant women, health and emergency workers and people caring
for infants. Those cuts would reduce the number of vaccinations
needed in the 1st round to about 40 million.
The last to be eligible for vaccine will be healthy people over 65,
who are least likely to contract swine flu but most likely to suffer
complications when they do become ill. The group recommended that
they not be offered vaccine until all the other groups had received it.
Some argued that any efforts to restrict vaccination, based on fears
of a shortage, inevitably confuse the public, discourage people from
being immunized and result in vaccine going to waste. "Tight
prioritization will result in vaccine being unused," said Dr. William
Schaffner, a nonvoting member of the group and an infectious disease
expert at Vanderbilt University. "When you have vaccine, just give it."
The decisions are being made against a backdrop of uncertainty and in
real time, as the pandemic continues to unfold in this country and
around the world. Health officials expect a surge of new cases when
schools open in the fall, but they cannot be sure.
The vaccine has not yet been tested for either safety or efficacy.
Government officials have projected that 120 million doses of vaccine
will be available by October [2009], but a number of participants at
the conference said they thought that was overly optimistic. "I think
the virus is beating us to the tape, and it will be the virus itself
that will immunize us in the fall," said Dr. Schaffner. He said he
feared a "double-barreled flu season," with many cases of swine flu
in the fall and early winter, and then a seasonal outbreak starting
later and peaking in February as it usually does.
[Byline: Denis Grady]
