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USA - Guidance on Allocating & Targeting Pandemic Influenza Vaccine

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  • USA - Guidance on Allocating & Targeting Pandemic Influenza Vaccine

    The US Department of Homeland Security and the Department of Health and Human Services have released the Guidance on Allocating and Targeting Pandemic Influenza Vaccine document.

    "Introduction


    Effective allocation of pandemic influenza vaccine will play a critical role in preventing influenza and reducing its effects on health and society when a pandemic arrives. The specific type of influenza that causes a pandemic will not be known until it occurs. Developing a new vaccine in response will take several months and pandemic vaccine may not be available when cases first occur in the United States. Moreover, once vaccine production begins, it will not be possible to make enough new vaccine to protect everyone in the early stages of a pandemic.

    The U.S. Government is taking steps to minimize the need to make vaccine allocation decisions by supporting efforts to increase domestic influenza vaccine production capacity. Significant funding is being provided to develop new vaccine technologies that allow production of enough pandemic influenza vaccine for any person in the United States who wants to be vaccinated within six months of a pandemic declaration. Until this goal is met, Federal, State, local and tribal governments, communities, and the private sector will need guidance on who should be vaccinated earlier during the pandemic to best protect our people, communities, and country.

    Issues to consider in drafting guidance on pandemic influenza vaccination are different and more complex than in developing recommendations for annual vaccination against seasonal influenza. In contrast with seasonal influenza, during a pandemic nobody in the population is likely to have immunity to the virus, many more people will become ill, and rates of severe illness, complications and death are likely to be much higher and more widely distributed throughout the population. The greater frequency and severity of disease will increase the burden on health care providers and institutions and may disrupt critical products and services in health care and other sectors. National and homeland security could be threatened if illness among military and other critical personnel reduces their capabilities. Because the needs that must be addressed by pandemic vaccination differ from seasonal influenza vaccination, the
    guidance on vaccination differs as well.

    This guidance is intended to provide strong advice to support planning an effective and consistent pandemic response by States and communities. Nevertheless, it is important that plans are flexible as the guidance may be modified based on the status of vaccine technology, the characteristics of pandemic illness, and risk groups for severe disease – factors that will remain unknown until a pandemic actually occurs.

    Vaccination will be only one of several tools that can be used to fight the spread of influenza when a pandemic emerges. Additional approaches include non-pharmaceutical public health measures in communities, businesses, and households to reduce and slow the spread of infection; using antiviral medications for treatment and prevention; using facemasks and respirators in appropriate settings; and washing hands and covering coughs and sneezes. These strategies will be the initial mainstay of a pandemic response before vaccine is available and continue to have important effects throughout a pandemic. Guidance around vaccine use is meant to be applied in conjunction with and in the context of these other pandemic response efforts. More information about pandemic planning and response measures is provided at www.pandemicflu.gov...."<o:p></o:p>


    Pandemic vaccine to be distributed using the following tier system:


    Tier 1 includes 24 million persons:

    Critical occupations
    - Deployed forces
    - Critical healthcare
    - EMS
    - Fire
    - Police
    High risk population
    - Pregnant women
    - Infants
    - Toddlers


    Tier 2 includes 15 million persons:

    Critical occupations
    - Military support
    - Border protection
    - National Guard
    - Intelligence services
    - Other natl. security
    - Pharmacists
    - Mortuary services
    - Community services
    - Utilities
    - Communications
    - Critical govt.
    High risk population
    - Infant contacts
    - High risk children


    Tier 3 includes 64 million persons:


    Critical occupations
    - Other active duty
    - Other healthcare
    - Other CI sectors
    - Other govt.
    High risk population
    - Healthy children


    Tier 4 includes 74 million persons:


    High risk population
    - High risk adults
    - Elderly


    Tier 5 is the rest of the population with 123 million persons.

  • #2
    Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

    This is an interesting priority list.

    It's understandably aimed at effectively protecting those who must fight the pandemic & children. However, it ignores critical private sector functions, like groceries, gas stations, etc. When the pandemic is over, the economy cannot function with only government workers and children.

    How do they define elderly? Some proposals have treated this group as "less than critical" or "disposable." However, many people in their 60s and sometimes 70s are activity heading corporations or making other important contributions. There is already some concern that when the baby-boomers all retire, there will be a critical shortage of business leadership.

    Perhaps we don't spend enough time considering the aftermath, epecially if it's a severe pandemic.

    .
    "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

    Comment


    • #3
      Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

      Originally posted by AlaskaDenise View Post
      This is an interesting priority list.

      It's understandably aimed at effectively protecting those who must fight the pandemic & children. However, it ignores critical private sector functions, like groceries, gas stations, etc. When the pandemic is over, the economy cannot function with only government workers and children.

      How do they define elderly? Some proposals have treated this group as "less than critical" or "disposable." However, many people in their 60s and sometimes 70s are activity heading corporations or making other important contributions. There is already some concern that when the baby-boomers all retire, there will be a critical shortage of business leadership.

      Perhaps we don't spend enough time considering the aftermath, epecially if it's a severe pandemic.

      .
      I can only hope that governments around the world will try a ''prime'' and ''boost'' approach, where the ''out of the list'' people could achieve a some degree of protection.

      I otherwise see a painful stride between the good intention of the US plan (perhaps one of the most advanced and deeply articulated) and the fate of millions with chronic conditions, cancers, mental disabilities, homeless, working poors, migrants and more other people without a precise ''usefulness'' in societal and economic continuity.

      Comment


      • #4
        Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

        ?(Adds criticism paragraphs 6-8) - US vaccination plan puts health care workers first

        23 Jul 2008 18:50:31 GMT
        Source: Reuters
        By Maggie Fox, Health and Science Editor

        WASHINGTON, July 23 (Reuters) -

        Essential health care workers would be immunized first if a flu pandemic broke out in the United States, the government said on Wednesday.

        The Department of Health and Human Services released long-awaited details on who would get vaccinated if and when a pandemic -- serious global influenza epidemic -- emerged.

        The plan puts a million health care workers, such as emergency room staff and nurses, at the top. Next are military and "mission critical" personnel, public health workers and hospital and nursing home staff.

        All of these play a "critical role in providing care for the sickest persons; highest risk of exposure and occupational infection," the plan reads.

        "This guidance is the result of a deliberative democratic process," HHS Secretary Mike Leavitt said in a statement. "This document represents the best of shared responsibility and decision-making."

        Mike Osterholm, an infectious disease expert at the University of Minnesota's Centers for Infectious Disease Research and Policy, said the plan did not do enough to protect critical workers.

        While it designates people involved in making vaccines and drugs for flu, it does not account for other drugs such as insulin and antibiotics, he said.

        "It does nothing to help support the manufacturing and transportation system for moving these drugs from offshore to the United States," Osterholm, who advised the government on the guidelines, said in a telephone interview.

        Many public health experts agree some sort of influenza pandemic is inevitable, although no one can predict when it might come and how severe it may be.

        It is also impossible to predict what strain of flu might cause it, although H5N1 avian influenza is the main suspect now. It has become entrenched in birds in Asia, Europe, the Middle East and possibly Africa.

        While just 385 people have been infected since 2003 and 243 have died, experts fear H5N1 could acquire the ability to spread easily from human to human, setting off a pandemic that could kill hundreds of millions of people.

        WAITING MONTHS
        Making enough vaccine to protect everyone would take months and so experts agree a plan is needed to determine who gets the first doses to come out of the factory.

        The HHS plan designates 700,000 "deployed and mission critical personnel" to follow the key health care workers. After that, 300,000 public health workers, 5.7 million inpatient and outpatient health care providers, and 1.6 million long-term care workers would be next to get the vaccine.

        "It should be noted that during the 1918 pandemic, more American soldiers died of illness than in combat during the First World War," the plan reads.
        Emergency services, law enforcement, makers of pandemic vaccines and drugs, pregnant women and babies and toddlers are also in the first designated groups.

        HHs said the plan, available at http://www.pandemicflu.gov/vaccine/a...onguidance.pdf , can be modified to meet the characteristics of any real pandemic.

        Healthy adults not in any other priority group come last.

        At least 16 manufacturers in 10 countries are working on vaccines against H5N1. Antiviral drugs can help protect people but they are also in short supply and the U.S. plan also calls for closing schools, limiting public gatherings and other measures to prevent flu transmission.

        (Editing by Alan Elsner and Will Dunham)
        -
        The intelligence, technology, and human expertise you need to find trusted answers.

        ------

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        • #5
          Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

          Full text PDF file format attached.
          Attached Files

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          • #6
            Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

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                      Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine



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                      • #12
                        Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

                        So they took out the govt leaders and added health care providers.
                        I guess they didn't hear us telling them keeping the grid up should be a priority?

                        Here was their original tier 1 compared to the new version:

                        Deployed and mission critical personnel 700,000; new 700,000

                        Public health personnel 300,000; new 300,000
                        Inpatient health care providers 3,200,000; new 3,200,000
                        Outpatient and home health providers 2,000,000; new 2,500,000
                        Health care providers in nursing homes 800,000; new 1,600,000 (LTCFs ?)

                        EMS, Law enforcement and Fire services 2,000,000, new 2,000,000
                        Manufacturers of pandemic vaccine & antivirals 50,000; new 50,000
                        Key government leaders 50,000; new= removed from this tier

                        Pregnant women 3,100,000; new 3,100,000
                        Infants & toddlers 6?35 mo old 10,300,000; new 10,300,000
                        The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

                        Comment


                        • #13
                          Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

                          They're taking a lot for granted.........

                          - assuming the gas to run emergency vehicles will be refined and delivered (by whom?).
                          - assuming roads will be plowed of snow (by whom)?
                          - assuming heating oil for hospitals, etc. will be available without refinery workers, train engineers, and delivery drivers.
                          - assuming the communications systems used by these emergency workers will be available without maintenance.
                          - assuming trash will be picked up and properly processed.
                          - assuming offices of the HCW and government workers will stay usable without janitorial staff.
                          - assuming government leaders will portray an approprate public image without a haircut.
                          - assuming vehicles used by all these personnel will continue to run without the services of mechanics, etc.

                          - assuming all involved can maintain their sanity without their local STARBUCKS!

                          Yep, the list of important people goes on and on.

                          .
                          "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

                          Comment


                          • #14
                            Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

                            Everyone in my family is in tier 5 - healthy middle-aged and young adults.

                            I think we all have to face the facts that:

                            1) The federal and state governments will be overwhelmed in a mass health emergency. They will not be able to provide substantial support to individual citizens.

                            2) At this time it appears that given the current status of vaccine development, the distribution of a safe and effective vaccine will "not happen" in the middle of a pandemic for the majority of the citizens.

                            3) That despite a valiant effort to guide how a vaccine distribution may actually occur, the logistical applications of such an event in the middle of a pandemic are problematic.

                            4) We are on our own with the same tools that we had in 1918. We will need to depend on non-pharmaceutical interventions and our close friends and relatives.


                            There will be no magic pill or shot to save us. The only thing that can save us is us.

                            Our compassion and faith in the human spirit.

                            Our desire to share what we have with others. Our willingness to help strangers. Our ability to teach about hand washing, social distancing, mask making, natural medicines, water purification, heating and cooking without electric power, home schooling, and other essential services.

                            We can do it.

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                            • #15
                              Re: USA - Guidance on Allocating &amp; Targeting Pandemic Influenza Vaccine

                              I am in a painful situation: when I am strongly against the current policy highlighted by this latest document about the pandemic vaccine priority, I am at the same time aware of the immense hurdles we will face during the next pandemic.

                              I acknowledge that no ''magic pill'' of ''magic shot'' exist, but it is also true that H5 vaccines are currently available and approved by international drugs evaluation agencies (EMEA, FDA for example).

                              We have two options:

                              * to tell general population about the impending threat of panflu and the absence of pharmacological intervention to reduce morbidity and mortality;

                              * to tell specific population sector, ie chronic conditions patients, cancer patients, HIV/AIDS, TB, mentally disabled, and more other (alzheimer, parkinson, muscular dystrophy...) that NO vaccine will be available even in the better scenario (as all are in the Tier 4 of the pandemic vaccines priority table);

                              * to tell the elderly of their fate.

                              This is the reality, or the reality that some authorities assume to be acceptable for population.

                              I think that other opinion should be take into account because even when one trust in full to his/her respective govt actual recent historical facts point against a ''full trust'' approach.

                              Obviously, this is MY OPINION, and doesn't imply the endorsement of anyone at FluTrackers forum and represents the result of a semi-illitterate member in such sensible fields.

                              And finally a question: Why does a pandemic vaccine plan not acknowledge the ''prime'' and ''boost'' immunological strategy to put in action at brief?

                              Even the HOPE may play a role in mitigating the despair in front of a potential disastrous pandemic.

                              But of course, dreams are out of the politicians mind .

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