Wednesday, July 23, 2008

HHS Guidance on Allocating And Targeting Pandemic Influenza Vaccine

# 2170

Today we have the long-awaited release of the HHS's (Dept. Health and Human Services) guidance on pandemic vaccine allocation called Guidance on Allocating and Targeting Pandemic Influenza Vaccine.

The release of this guidance document was coordinated with a teleconference held by the HHS, with Dr. William Raub, Dr. Bruce Gellin, Dr Ben Schwartz, and Dr. Jon Krohmer making brief presentations.

As Dr. William Raub pointed out, a targeted pandemic vaccine won't begin rolling off the production lines for 20 weeks, and then, only in limited quantities.

And Dr. Bruce Gellin made it clear that while there are great hopes for faster vaccine production techniques in the future, plans must be made based on our current capacity.

For now, the availability of a strain specific vaccine for a pandemic will be extremely limited during the first six months, and possibly longer, into a pandemic crisis.

Anytime you have to prioritize who will receive a potentially life-saving vaccine first - and who will have to wait - there will controversy. No plan is likely to please everyone.

Still, I have to say I generally agree with the decisions arrived at in this guidance document. I also recognize how tough making these decisions had to have been.

Below is a chart showing the 5 tiers, and if the supply of vaccine is extremely scarce, the priority within each tier (running top to bottom).

(click to enlarge)

There are variations to these tiers at different pandemic levels (Cat 1-5).

The one's listed here assume a CAT 4 or CAT 5 pandemic. Tier 1 priorities remain the same at all pandemic intensities, but adjustments may be made to lower tiers depending on the virulence of a pandemic.

Tier 1

As you can see, tier 1 consists of those people who are crucial to maintaining our safety and infrastructure, along with pregnant women (very high risk, based on the 1918 pandemic) and toddlers.

Tier 2

Tier 2 encompasses critical occupations and High Risk populations.

Tier 3

Less critical occupations are included in tier 3, along with healthy children.

Tier 4

The elderly are positioned ahead of the general population, but after children and critical infrastructure and health care workers.

Tier 5

The last tier are healthy adults not involved in critical infrastructure or health care.

The entire guidance document is well worth downloading and reviewing. While a major step forward, this document is just part of the job ahead. Here is how the guidance document puts it.

Next Steps and What States and Communities Can Do

This guidance is the result of careful and rigorous consideration of scientific data, historical analyses, ethical issues, and comments from government agencies, key stakeholders at the national, State, and local/community levels, and members of the general public.

The development of vaccine prioritization guidance, however, is only one step toward planning and implementing an effective pandemic vaccination program. Strategies for how persons in occupationally defined target groups should be identified and how their priority can be verified at the time of vaccination must be developed.

State, local, and tribal planners also must plan for allocation and distribution of vaccine to sites where it will be administered, vaccination clinic procedures, and programs to monitor coverage and potential adverse events. Strategies and materials also must be developed for employers and the public to clearly communicate the vaccine targeting strategy and support it’s implementation.

I'll certainly have more on this subject in the future. For now, though, I have to agree that putting health care workers, and critical infrastructure and national security personnel at the head of the line makes sense to me.

I imagine there will be some discussion over the relative placement of various essential workers, particularly in the lower tiers. My first thought, looking at the list, was that transportation ought to be higher than tier 3. Supply chain problems are likely to cause cascade effects throughout the economy, and could endanger our ability to maintain our critical infrastructures.

That question was raised by Robert Roos of CIDRAP, and briefly addressed during the tele-conference.

It was stated that demands on transportation will probably decrease during a pandemic, and that the transportation system has fungibility- some measure of redundancy built in. It was also suggested that truckers were unlikely to be at increased risk of occupational exposure.


I'm certain there is no perfect solution here. Compromises have to be made, and it is the nature of the beast that no one comes away totally pleased with the result.

And quite honestly, no one will know if the right decisions were made about this, or anything else, until after the next pandemic arrives.

Last edited 7/23 3:40 EDT