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Scarce pandemic vaccine to be given in order


By Anita Manning, USA TODAY

In the early weeks of a flu pandemic, the first to receive scarce supplies of vaccine will include the military, medical and emergency workers, pregnant women and babies — nearly 23 million people — under a draft federal plan to be outlined Tuesday in Washington.

At the back of the pack, in a pandemic of the sort that killed 500,000 Americans in 1918, would be 74 million sick and elderly adults and 122 million healthy people ages 19-64.

The plan was developed by a government working group that met with scientists and business and community representatives over several months. It provides guidelines for pandemic planners and offers a glimpse into some agonizing decisions that could be necessary in the context of a swift-moving infectious disease and a shortage of protective vaccine.

"Once a pandemic starts, vaccine will come rolling off the line in lots, so there has to be a priority scheme on who would receive it first," says William Raub, science adviser to Health and Human Services Secretary Michael Leavitt.

"The committee tried to identify those who would be critical to national and homeland security, critical to fighting the flu itself, and critical to maintaining a functioning society."

In meetings, the working group and other participants highlighted pregnant women and children as a priority, the report says. This also is an efficient use of vaccine, it says, because immunizing pregnant women protects their newborns, too, and children need lower doses, stretching limited supplies.

Jeffrey Levi of Trust for America's Health, an advocacy group, says the report, being presented at a meeting of the National Vaccine Advisory Committee, is "logical," but more discussion is needed to refine how vaccine will be distributed and used in different populations.

The plan provides for changes based on local needs and severity. In mild pandemics, which cause fewer deaths among the young and healthy, it makes sense to move those at risk of serious illness, such as the elderly and people with chronic illnesses, higher on the list, Raub says.

For instance, the plan doesn't target such groups as banking, food and agriculture, postal or chemical workers in a mild or moderate pandemic. But in a severe pandemic, those groups are in the third tier for vaccination, just behind electricity, natural gas, communications and water personnel and essential government workers.

"The more severe the pandemic, the more aggressive people would be in trying to protect critical workers," Raub says. "But if it's at the milder end, critical workers would be a smaller group, so there would be more emphasis on getting everyone vaccinated. The disruption of society wouldn't be the same."

A pandemic occurs when a new flu virus emerges that can spread as easily as the seasonal flu, which causes 200,000 hospitalizations and 36,000 deaths each year. Because it's different from known flu viruses, people have no built-in immunity, so everyone is at risk.
Planning for the next possible pandemic moved into high gear when a new flu strain, H5N1, also known as bird flu, emerged 10 years ago and began causing illness and death in humans. The World Health Organization warned then that the world could be "on the brink" of the next pandemic. Since 2003, WHO has documented 331 human cases, including 203 deaths from the virus, most of them in Southeast Asia.