# 3367
While no final decision has been made on whether to attempt a mass vaccination in the United States against the H1N1 `swine’ flu virus, work is moving forward on producing and testing a vaccine.
Sometime next month clinical trials are expected to begin, to determine the safety, and efficacy, of the vaccine currently under production.
Which means that – assuming everything goes well – it would be mid-October before any (limited) public vaccination program could begin.
During one of the break out sessions in yesterday’s Flu summit, Dr. Bruce Gellin updated officials on the prospects for a vaccine this fall. That session wasn’t broadcast live, but is expected to be archived and available in the next few days.
Luckily Maggie Fox of Reuters has coverage of the meeting. Follow the link to read it in its entirety, and then I’ll have some comments when you return.
U.S. government to pay for flu vaccine campaign
By Maggie Fox, Health and Science Editor
July 9, 2009
WASHINGTON (Reuters) - The U.S. government will pay for any vaccination program against the H1N1 swine flu, and may encourage schools to help vaccinate children, Health and Human Services Secretary Kathleen Sebelius said on Thursday.
The government is also considering buying even more antiviral drugs, including more of GlaxoSmithKline's inhaled drug Relenza and pediatric doses of Roche AG's Tamiflu, officials told a swine flu "summit" at the National Institutes of Health.
Sebelius said plans were on track for a mid-October vaccination program, and she urged states and territories to get plans in place now. It will likely run alongside the annual seasonal flu vaccine campaign and may include schools and other non-traditional sites as vaccination centers.
"At mid-October we might have as much as 100 million doses of vaccine," HHS vaccine expert Dr. Bruce Gellin told the meeting.
Right now, we don’t know how much antigen will be needed per shot, nor how many shots are going to be needed to convey protection. And both issues would have a huge impact on how many people can be vaccinated this fall.
The assumption is that Adults would need two shots – about 4 weeks apart – to provide reasonable (+- 70%) immunity. It has even been suggested that children might even need 3 shots, although we will have to wait for clinical trials to know.
So 100 million doses might only inoculate somewhere between 33 million and 50 million people.
Maybe more. But we’ll just have to wait and see.
As far as who gets these first vaccines, that decision hasn’t been made, although the following groups are under consideration for being in the first priority tier.
- Students and staff (all ages) associated with schools (K-12th grade) and children (age ≥6 months) and staff (all ages) in child care centers.
- Pregnant women, children 6 months – 4 years of age, new parents and household contacts of children <6 months of age.
- Non-elderly adults (age <65 years) with medical conditions that increase the risk of complications of influenza.
- Health care workers and emergency services sector personnel (regardless of age).
There will be ongoing discussions over the summer to try to finalize these groups, and a decision probably in September, as to whether to pull the `vaccination trigger’.
A massive vaccination program is an enormous undertaking, and carries with it a certain amount of political risk.
The last time it was attempted – in 1976 for another swine flu threat – it became a fiasco (see Deja Flu, All Over Again).
While vaccine technology has improved over the past 30 years, anytime you give hundreds of millions of doses of a vaccine to a population, a certain number of adverse effects are bound to crop up.
Some may be due to the vaccine, while others may be coincidental. But either way I expect the press, and the anti-vaccine crowd, will play them to the hilt.
This has the potential to derail any vaccination program, and will be huge public relations challenge for public health officials.
We are about to ask our public health infrastructure to take on an enormous task, at a time when their budgets, and staffing, are greatly diminished. They will also have to deal with flu-related absenteeism, along with all other existing public health threats.
The world doesn’t stop for a pandemic.
Over the next couple of years there will still be floods, hurricanes, tornadoes, outbreaks of food poisoning, water supplies to check, and myriad other public health issues to stay on top of.
Swine flu isn’t going to be the last public health threat to come down the pike. It is simply the latest.
Hopefully through this pandemic we’ll figure out, as a nation, how important public health and safety really is, and begin restoring (and increasing) the funding for it.
It really is a national security issue of the highest order. We should fund it like one.
