(UPDATED)
# 3638
Those who read my blog last Friday ( see Revised Vaccine Estimates From NBSB Meeting) or Lisa Schnirring’s excellent coverage at CIDRAP (see Officials lower expectations for size of first novel flu vaccine deliveries) are already aware that the quantity of pandemic vaccine now expected to be delivered in October is much lower than had been projected just a couple of weeks ago.
This news was announced during Friday’s NBSB meeting, but since it was released on a Friday afternoon, and not followed up by the HHS until yesterday, it is just now starting to get some mainstream media play.
Maggie Fox of Reuters brings us the latest details. Follow the links to read it in its entirety. When you return, we’ll talk about how this may affect the vaccination program this fall.
U.S. cuts doses of flu vaccine
Only 45 million to be delivered
By Maggie Fox REUTERS NEWS AGENCY | Tuesday, August 18, 2009
U.S. health officials on Monday said they have slashed their estimate of how many swine flu vaccine doses will be available for the start of a mass vaccination campaign in the fall.
Citing delays in manufacturing and packaging the vaccines, the Department of Health and Human Services said only 45 million doses of the new H1N1 vaccine would be on hand in mid-October, instead of the 120 million previously forecast.
The revised delivery guidelines would push back a federal government estimate that all those requiring vaccinations be immunized by the first week of December.
"Our latest information from the manufacturers tells us that we now expect to have about 45 million doses by October 15 with approximately 20 million doses being delivered each week thereafter, up to the 195 million doses that we have purchased," Bill Hall, an HHS spokesman, said in e-mail.
On July 29th at the ACIP meeting (see The ACIP Committee Recommendations) we learned of plans to target roughly 159 million `higher risk’ Americans with a vaccination program this fall, and the hopes that all Americans who want a shot will be offered one in the months that follow.
These target groups assumed that adequate quantities of vaccine would be available in October, and are made up of:
Pregnant women (4 Million)
Household contacts and caregivers of children under 6 mos (who cannot receive a vaccination themselves) (5 Million)
Health Care Workers & Medical Service Personnel (14 million)
Children and adolescents aged 6mos –24yrs (102 Million)
Persons aged 25-64 years of age with certain Medical Conditions (34 million)
The assumption is that it will take 2 shots, 3 weeks apart, to confer reasonable immunity. The maximum immune response is expected to come about 2-weeks after the (2nd) booster shot is received.
In other words, those that get their first shot on October 15th would be in line to get a booster around Nov 10th, and would hopefully have achieved acceptable immunity by Thanksgiving.
Of course, even if you had the vaccine, you couldn’t vaccinate 159 million people in a single day. Or even a week, or probably even a month.
No one really knows how long this is going to take, and a lot will depend on the public reception of the vaccination program. In 1976, during the last emergency vaccination program, we only managed (amid bad publicity) to vaccinate 40 million Americans over a 10-week period of time.
It seems reasonable to assume, due to problems of logistics or supply, that some higher-risk Americans may not be offered their first shot until sometime in November or even December.
While it was it was hoped that it would not be needed, as a fallback position - in the event of a major shortfall of vaccine – ACIP identified a smaller `subgroup’ who could receive prioritization for the vaccine.
This priority group consists of roughly 42 million people.
Pregnant women (4 million)
Household contacts of Infants < 6mos (5 Million)
Health Care Workers With Direct Patient Contact (9 Million)
Children aged 6mos – 4 yrs (18 million)
Children under 19 with chronic medical conditions (6 Million)
No doubt there are now discussions ongoing about what to do about this expected vaccine shortfall.
Whether to concentrate on this smaller subgroup? Or to go ahead with the larger 159 million-person priority group as originally planned?
UPDATE: It appears, based on reporting from ABC News this morning, that the decision is leaning towards going with this 42 million person cohort.
Swine Flu Vaccine: Enough to Go Around?
Health Officials Say Only a Third of Planned Doses Will Be Ready by Mid-October
By DAN CHILDS
Government health officials said on Monday that the United States will have barely more than a third of the 120 million doses of swine flu they hoped would be available by mid-October,. That's far less than the 160 million doses they originally predicted in July.
Bill Hall, spokesman for the U.S. Department of Health and Human Services, said that despite the projection that only 45 million doses will be available at the start of the mass vaccination campaign scheduled to start in October, there would still be enough vaccine available to achieve the primary goal of vaccinating the groups most in need, including pregnant women; children under four years old and public health workers.
"Our priority groups for vaccination have not changed," he said. "We still have enough vaccine to cover the priority groups identified."
Complicating matters, no one knows how many people in these priority groups will want the shot, or how quickly they will decide to take it. If the virus remains relatively `mild’, the demand for the vaccine may not be as great as first believed.
Some people may decide to take a `wait and see’ attitude with regards to this virus – and the vaccine - which may take some of the pressure off the supply problem. Conversely, once people learn the vaccine is in short supply, that could drive up demand.
In other words, there is a lot to consider here, and the answers are not immediately obvious.
The only thing that is obvious in all of this is that public health officials are going to have their hands full dealing with a complex and fluid situation this fall.
