Re: Japan to vaccinate medical workers for bird flu
Good luck, this sort of program has proved difficult in the past... (not to mention it seems that they are using a questionable strain of the virus) (I think the largest attempt of this nature would be the US in 1976, see below)
Japan to vaccinate medical workers against bird flu
TOKYO (AFP) ? Japan is to vaccinate thousands of medical workers and officials against bird flu to prepare for a possible pandemic, a health ministry official said Wednesday.
The ministry will vaccinate about 6,400 people by next March and plans eventually to expand the programme to about 10 million people including police and military officers, the official said on condition of anonymity.
"I believe it would be the world's first plan to vaccinate thousands of people" for a possible outbreak of a new type of flu, he said.
Japan has stockpiles of so-called pre-pandemic vaccines for 20 million people.
The official said the government will study the effectiveness and side effects of the vaccines, which are expected to be given to volunteers.
"Once the effectiveness and safety of the vaccines are known, the government will consider expanding it to a scale of some 10 million people," he said.
The H5N1 strain has killed more than 230 people worldwide since late 2003.
Experts fear the virus, which is usually spread directly from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.
Health minister Yoichi Masuzoe on Tuesday proposed using part of the government's stockpiled vaccines on workers at hospitals or quarantine, customs and immigration offices.
The plan was backed Wednesday by a government-appointed panel of experts.
"If we obtain good results over its effectiveness and safety, we want to consider vaccinating (an additional) 10 million people who are in medical occupations" or other key jobs such as at utilities, Masuzoe said.
The ministry panel also approved plans to increase the vaccine stockpile and to try to shorten to six months the period needed to produce an effective vaccine if a pandemic occurs. It currently takes 18 months.
Japan saw several outbreaks of the deadly H5N1 strain in early 2007, leading authorities to kill tens of thousands of chickens as a precaution, but it has reported no human deaths.
http://afp.google.com/article/ALeqM5...mzziKZAOVNqubA
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Here are some excerpts from
Are We Ready? Public Health Since 9/11 by David Rosner and Gerald Markowitz (2006)
Joseph Henderson suggests that smallpox became a primary focus since it appears as the only disease on CDC's Catergory A list that is preventable with a vaccine...
Gene Matthews basically supported the view that smallpox had to be taken off the table, 'my view was that CDC could not afford to assume that this is not a real threat'. It is these kinds of low-risk, high-consequence issues that drive people in government crazy.
.... Maintaining confidence in health agencies becomes all the more important because Matthews and other federal officals consider an attack a question not of if but of when.
Jeffrey Koplan is a bit more specific in assessing the problems for public health infrastructure resulting from an increasing focus on bioterrorism: "We are a public health agency, not a part of the military. We had a culture where it was easy to have interchanges among scientists and we realized the need to reach out to the coummunity. The bioterrorism concerns were real but were at odds with the ways of public health's doing things. By its very nature bioterrorism has close ties to law enforcement and the military. Public health does not have close ties to these intstitutions but rather seeks ties to community groups."
While the possible breakdown in public trust threatens public health services, Hardy argues that there are also real benefits to the new attention to the influence of the military on public health bureaucracies. "The biggest problem in public health is how leaders respond in times of crisis. I have helped develop a national preparedness leadership initiative with the Kennedy School and the School of Public Health at Harvard... for forty officials in pulblic health, emergency preparedness, and senior staffers in Congress. We have not had leaders bold enough to take the right moves at the right time. This is the weakest link in the chain."
The ideological disagreements about the best focus for public health play out in the relationship between public health officials and the Department of Homeland Security. While Ed Thompson argues that this relationship "is developing," George Hardy sees "good and bad things in the establishment of the DHS - one of the really good things is that Homeland Security is really eager to learn about public helath - what it does and how to include it in their thinking. Hence public health is much more integrated into the state response apparatus than ever before"
from the Conclusion What Lessons Have We Learned from the book Are We Ready? Public Health Since 9/11 by David Rosner and Gerald Markowitz (2006)
Much of the success of the public health response to 9/11 in New York City had less to do with formal emergency planning or conscious preparation than with the presence of an existing infrasturcture of health services, laboratories, and personnel. Though many officials outside the city praised New York's ability to take action during the crisis, and some personalized its success by attributing it to the political leadership,
in fact the work was done by bureaucracies that nothing and no one could have mobilized had they not already been there.
Another message that comes through loud and clear is that failure to communicate honestly about uncertainty is a big mistake. The issuance of pronouncements that obviously are not supported by everyday observations will in the end backfire, as the public officials making such claims are certain to lose the public's trust and goodwill and ultimatley their authority.
Finally, when national threats are present, clear lines of federal and other authority need to be established. Local authority need not be usurped, but decisive leaders who control resources and make decisions with good personal and situational intelligence are required in times of crises.
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Here are some interesting excerpts from
State of Immunity, The Politics of Vaccination in Tweintieth-Century America , 2006, by James Colgrove..
Smallpox
It was thus against a a backdrop of confusion among the public, sharp disagreements among health professionals, bioterrorism experts, and politicians about risks, benefits, and precautionary action, and the buildup to an increasingly likely war with Iraq that President George W. Bush announced a comprehensive plan to protect the nation from smallpox in mid December 2002. While admitting that his administration had 'no information that a smallpox attack is imminent,' Bush outlined an ambitious three-phase plan. In the first phase, about half a million health care workers and emergency personnel were to be vaccinated within thirty days. Thereupon a broader effort would commence, targeting some 10 million health care workers. Finally, in late spring or early summer, the vaccine would be made available to any adult for whom it was not medically contraindicated.
In recommending such a large-scale operation, the administration had, in an unprecedented move, overruled the advice of the federal Advisory Committee on Immunization Practices.
Former CDC director William Foege was among many who publicly criticized the scope of the plan. Foege's years of experience on the front lines of the global smallpox eradication program in the 1970s gave him special credibility on this issue, which he drew upon when he argued in a Washington Post op-ed column that ring vaccination, not blanketing the general population, was the wisest course of action. Ring vaccination had been effective, he wrote, even in a place like India, with its high population density, millions on trains at any one time and many people without actual addresses. For anyone not involved in that effort, ring vaccination seemed--and probably still seems-- counterintuitive. But in India we went from the highest incidence of smallpox recorded in decades in May 1974 to zero in May 1975... Compare this with the record of mass vaccination programs, which had been tried in India for more than 150 years without success . The key to fighting smallpox proved to be not background immunity but diligence in finding and vaccinating every possible contact of every patient.
Because of the administration's failure to win the support of frontline health care providers around the country, the program never met the goal laid out in phase one, much less progressed to the second or third stages. Out of the half a million health care workers targeted to receive the vaccine in the first phase, less that ten percent--approximately 40,000 people nationwide--were vaccinated
Anthrax
Another vaccine dispute emerged from the US military. In December 1997, US Defense Secretary William Cohen announced a plan to vaccinate all 2.4 million members of the military against anthrax, a highly lethal bacterial infection. It was the first time that the military had attempted to immunize all active and reserve members against a potential biological weapon, and reflected a growing concern that countries hostile to the United States were developing a variety of agents that could be used for chemical warfare. The vaccine--administered in six injections over the course of eighteen months--was known to cause minor side effects such as pain and swelling at the infection site, headache, and fever, but rumors soon began to circulate among service members that it could cause sterility and paralysis. Many soldiers refused the shots and, in so doing, faced a variety of disciplinary actions, including court-martial,. The resistance was fueled in part by widespread mistrust of the military's past responses to soldiers' health problems, including its failure to be forthcoming about issues such as Agent Orange and Gulf War Syndrome. By eary 2000, some three hundred fifty service members had refused the shots, and an unknown number had left the service rather than be forced to undergo them. The problems with morale and refusal attracted the attention of some members of Congress, who called on the Pentagon to suspend the program in light of concerns about the vaccine's safety and efficacy.
Swine Flu
In 1976, the CDC had to deal with one of the most difficult crises in its history: forestalling a feared epidemic of swine flu.
In January 1976, an army cadet at Fort Dix in New Jersey died of the flu. A culture of the virus revealed that the strain was closely related to the one that had caused the worldwide influenza pandemic in 1918 that had killed at least 20 million people. Alarmed officials at the CDC considered mounting a mass campaign to protect every American from the possible reemergence of the deadly strain. In April, David Sencer, the CDC's director, recommended that a mass vaccination program go forward and President Gerald Ford announced it to the country.
In a survey in New York City in mid November, more than half the respondents said they had not been vaccinated and did not intend to be, citing as reasons that the vaccine was unnecessary, that they were afraid of it, or that their physician had recommended against it.
By mid December more than fifty cases of Guillain-Barre Syndrome had been reported, the majority of cases had received the vaccine within the previous month. On December 16, 1976, the program was suspended, never to resume.
Some 40 million people had received the vaccine. Although this was the largest number of people ever vaccinated in a single mass campaign, it was less than one-fifth of the national target population. 
