# 3453
A recurring theme in this blog has been the enormous difficulties involved in manufacturing, and delivering, a emergency influenza vaccine to the general population in say – the first year of a pandemic.
Just a few of the more recent entries include:
Branswell On Vaccine Testing
A Vaccine Reality Check From The CDC
Vaccine Expectations
The Tracks Of Our Tiers
A Vaccine Reality Check
CIDRAP News: Major Hurdles To Get To A Vaccine
While the United States is pursuing a vaccine, the CDC has been intentionally noncommittal regarding the delivery dates and quantity of vaccines that the American people can expect.
For now, no decision to provide mass inoculations has even been announced by the CDC or HHS. There are a great many obstacles that must be overcome first – not the least of which are safety and efficacy studies of this new vaccine.
Given the debacle of the 1976 mass vaccination campaign against a different swine flu threat (see Deja Flu, All Over Again), U.S. public health officials are understandably cautious when it comes to launching another national immunization program.
Other countries (and many media outlets) haven’t been as reticent to promise a `swine flu vaccine in the fall’. In a few European countries, we’ve seen some pretty bold promises.
Even here in the United States, inexplicably, I often see media references to this `likely’ vaccine availability. Despite constant reminders from the CDC that no decision has been made.
Rarely, if ever, do these reports mention the minor point that if and when a vaccine becomes available, it will be in very short supply for many months.
Also seldom mentione are that high risk groups, and those vital to national security, will be prioritized to receive the jab first, and that the `average’ person may have a very long wait to be immunized.
Typical of such coverage is this, which appeared in the Daily Record on May 14th.
Scottish government to buy up enough swine flu vaccine for entire population
May 14 2009
THE Scottish government is to buy up enough swine flu vaccine to immunise the entire population, it was revealed today.
The move was disclosed by Health Secretary Nicola Sturgeon when she updated Parliament on latest efforts in the fight to contain the virus.
<snip>
The aim was to secure enough supplies to allow vaccination of the whole population.
Ms Sturgeon said the UK had advance supply contracts in place for a pandemic vaccine, but this could only be triggered in certain circumstances - like the World Health Organization declaring Phase 6 of a pandemic.
"Obviously we do not know when or if these triggers will be reached," she said.
"We do know that if we simply wait until then we risk losing the capacity manufacturers have available now which would allow us to build up a stockpile and get a vaccination programme under way before the winter.
All very optimistic. In fact, the only cautionary note was raised by Ms. Sturgeon further down the article where she stated:
"Under any scenario and even after our sleeping contracts kick in, it will be a number of months before we get supplies sufficient for 100% of the population," she said.
This caveat aside, the average resident of Scotland – reading this report - can be forgiven for believing that they’d be rolling up their sleeve to get a swine flu jab this fall.
Today the word is: Not so fast.
It now turns out that `a number of months’ may be a year-and-a-half. At least according to this story which appeared in the Scotsman overnight.
Swine flu: Scots will be forced to wait 1½ years for full vaccination
Published Date: 08 July 2009
By Tom Peterkin
HEALTH bosses have admitted that the NHS will not be able to vaccinate all of the Scottish population against swine flu until November 2010 – almost 1½ years away.
The admission led to calls for action to ensure that Scotland does not suffer a vaccine shortage as the pandemic intensifies.
Experts have predicted that the number of swine-flu cases in Scotland will soar to 10,000 a day by the end of August and doctors are anticipating for a rapid increase of the illness over the winter.
The fact that it will be 16 months before there is enough vaccine to cover the entire Scottish population was revealed in a letter from Kevin Woods, the NHS Scotland chief executive, to local NHS board officials.
The letter states: "According to current delivery estimates vaccine for 100 per cent of the population could be received by November 2010."
The letter went on to say that "a significant proportion ... possibly enough to vaccinate half the population" of the vaccine stock would arrive before the end of December this year. The first batches will arrive in August.
The letter added: "Delivery of the H1N1 vaccination programme will be a significant challenge for the NHS in Scotland, unprecedented in scale and scope."
Mary Scanlon, the Conservative health spokeswoman, said: "There was an understanding that there would be sufficient vaccine for all the population over the forthcoming winter months.
"People with asthma and diabetes, and health workers have to be prioritised. I think this is of concern, particularly given that we are told that the swine flu virus is likely to mutate into something more serious."
For the first time, we are beginning to see some public disclosure of the realities of a massive pandemic immunization program.
Simply put: It isn’t going to happen overnight.
Why it has taken until now for this realization to hit is difficult to fathom. I can’t believe much has been gained by all of this `talking up’ of a vaccine in the fall.
But you can expect more `news’ like this over the coming months.
Vaccine supplies are going to be very limited, at least in the early going. And right now, we don’t even know if it will take one or (more likely) two shots to convey immunity.
Promises of `vaccines available in August or September’, which seem to be permeating the global media over the past few weeks, totally ignore the realities of limited supply, and the logistics of delivering the vaccine to the public.
Sure, there may be some limited supplies of vaccine available in some countries by August of September.
But the implied message – that enough vaccine will be available for the general public in the fall, or at least by winter – is false.
High risk groups (like health care workers, pregnant women, asthmatics, etc.) – in a handful of richer, industrialized nations – are likely to be offered a vaccine this fall or winter.
Gradually, over months, the rest of their populations may see a vaccine. Many probably won’t until sometime in 2010.
For the vast majority of the world’s population, a swine flu vaccine in 2010 isn’t even on the table.
Our global manufacturing capacity and health care delivery systems aren’t anywhere near adequate for the task of immunizing 6 billion plus people over a year’s time.
Only recently has our funding of vaccine and influenza research escalated. And global budgets for public health delivery systems are far below where they need to be.
Two of the big reasons why a great many people are going to be a greater risk this year from the swine flu.
It’s the price we pay for having the vial half empty.
