On June 26th, 2008, Ian Fennell provided an editorial in the “Idaho State Journal” concerning pandemic flu at http://www.pocatelloshops.com/new_blogs/fennell/?p=4029. One comment on that blog was
Disgusted Reader Says:
July 14th, 2008 at 7:20 am
One observation: The flu hit here this winter. Huge number of flu shots for everyone. Wrong type of flu. It was a miserable flu season for everyone. More problem than just one.
The flu vaccine is a complicated issue and takes about a year to complete each year’s annual flu vaccine cycle. Federal officials and vaccine makers must decide 12 months in advance what strain of the flu their vaccine will target. They get to choose three strains out of a virtually unlimited number. Their historical record is very good, but last year was definitely not a success.
The above situation provides a background to when a vaccine will be available for our exercise scenario. In our exercise, the World Health Organization and the Center for Disease Control and Prevention have determined the virus strain that is causing the pandemic, and it will now take 4-6 months for that strain to be in a vaccine and in the hands of someone who can give each citizen a shot. That’s a long time away when 30% of the population will have been sick and recovered by the time the vaccine arrives, and 2% of those who get sick will have died.
The learning point here is that effective vaccines are not expected to be available when pandemic flu first hits. Quick actions in regards to non-pharmaceutical interventions will be key in keeping yourself and your community as healthy as possible. Personal preparedness in terms of supplies and voluntary isolation will greatly enhance your chances of survival. DO NOT RELY ON THE PROVERBIAL “MAGIC PILL” TO SAVE YOU. An effective vaccine will not be available for 4-6 months after the pandemic flu strain is identified.
The CDC has published draft vaccine priorties at http://www.pandemicflu.gov/vaccine/prioritization.html Here in southeast Idaho, we expect to use these same guidelines.
Below are the priority groups to receive vaccines for pandemic flu once they are available. Highest prioritiy is at the top. The general population will receive vaccinations after emergency responders and other priority workers listed at http://www.pandemicflu.gov/vaccine/prioritization.html
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LEVEL |
General Population (GP) |
|---|---|
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A |
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B |
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C |
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D |
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July 23, 2008 at 10:00 am |
This CDC Vax Priority plan came out of this webdialog
http://www.webdialogues.net/cs/panflu-engage-home/view/di/104?x-t=home
it is an extensive discussion about the priority of the vax program.
July 23, 2008 at 10:04 am |
Goju: thanks for that link! I’ve added it to the blog links. I hadn’t seen that before.
July 23, 2008 at 10:06 am |
It is interesting that the prime age range for death as of now for H5N1 is between 10-40.
It is also the same age range as most of our critical infrastructure workers.
We attempted to get the priority changed into that category first. If the grid falls, there goes the nation.
I guess we didn’t succeed.
July 23, 2008 at 11:58 am |
Goju,
Hi. Good points. The 10 to 19 year olds are very mobile, social and not the most hygenic.
The 19 to 40 group takes care of infrastructure, transport, medical care, etc.
BTW – First responders and HCW come before GP. In theory Doctors, nurses and EMTs get the shot before the CEO, hospital admin or clergy.
Note US population is 304.6 million. (World population is 6.7 billion) so 13 million shots is not alot. It does not cover tourists, students and workers on visas.
Note – some people are allergic to eggs so expect secondary effects.
Note: not everyone gets a flu shot. H5N1 is deadly. I re-phrase the question as “If there was a vaccine that would protect you from ever getting HIV or AIDS would you get it?” H5N1 is not yearly flu. History note: after the 9/11 anthrax letters everyone wanted Cipro.
Yes – they are looking at lots of new ways to make vaccines but so far they are tests.
For the first few months NPIs are the best we have.
Regards,
Kobie
“Well done is better than well said.
July 23, 2008 at 1:37 pm |
HHS and DHS Announce Guidance on Pandemic Vaccination Allocation
Release Date: July 23, 2008
For Immediate Release
Office of the Press Secretary
Contact: 202-282-8010
The U.S. Departments of Health and Human Services (HHS) and Homeland Security (DHS) released guidance on allocating and targeting pandemic influenza vaccine. The guidance provides a planning framework to help state, tribal, local and community leaders ensure that vaccine allocation and use will reduce the impact of a pandemic on public health and minimize disruption to society and the economy.
“This guidance is the result of a deliberative democratic process,” HHS Secretary Mike Leavitt said. “All interested parties took part in the dialogue; we are confident that this document represents the best of shared responsibility and decision-making.”
“A severe pandemic has the potential to disrupt our everyday way of life,” said DHS Assistant Secretary for Health Affairs and Chief Medical Officer Dr. Jeffrey Runge. “This guidance was developed to ensure that our nation’s critical infrastructure remains up and running and we address the needs of all of our citizens, enabling the country to recover from a pandemic more quickly.”
As part of developing the guidance, HHS held day-long public engagement and stakeholder meetings throughout the country and received more than 200 written public comments on the goals and objectives of pandemic vaccination. In all the meetings, stakeholders and the public identified the same four vaccination program objectives as the most important:
Protect persons critical to the pandemic response and who provide care for persons with pandemic illness;
Protect persons who provide essential community services;
Protect persons who are at high risk of infection because of their occupation; and
Protect children.
The guidance is also firmly rooted in the most up-to-date scientific information available and directly considers the values of our society and the ethical issues involved in planning a phased approach to pandemic vaccination.
The ultimate goal of the pandemic vaccination program is to vaccinate every person in the United States who wants to be vaccinated. Because pandemic vaccine cannot be made fast enough for everyone to be vaccinated at once, federal, state, local and tribal governments, communities, and the private sector can use the guidance to decide who should be vaccinated during this early stage to best protect people and communities.
The guidance’s vaccination structure defines four broad target groups: people who 1) maintain homeland and national security, 2) provide health care and community support services, 3) maintain critical infrastructure and 4) are in the general population.
Everyone in the United States is included in at least one vaccination target group. People who are not included in any occupational group would be vaccinated as part of the general population based on their age and health status.
While vaccines are an important resource in a pandemic, vaccination will only be one of several tools to fight the spread of influenza if and when a pandemic emerges. Other tools include community public health measures, antiviral medications, facemasks and respirators, washing hands, and covering coughs and sneezes.
###http://www.dhs.gov/xnews/releases/pr_1216831362171.shtm
July 23, 2008 at 2:03 pm |
Laqueta: thanks for the quite timely information. The full guidance report can be found at http://www.pandemicflu.gov/vaccine/allocationguidance.pdf
July 23, 2008 at 3:31 pm |
Good comments on the vaccine prioritization process…
…but I’m feeling vaguely uneasy.
It appears there was a lot of effort to involve and communicate with stakeholders. Why? I am guessing that informed and knowledgeable people at senior government levels recognized pandemic flu as a credible threat. It would be an ‘event of national significance.’ The leading candidate (H5N1) is lethal, and if it goes/mutates pandemic, may be highly contagious and highly communicable – killing by respiratory attack, sometimes including vital organs. And the critical infrastructure/supply chain is very vulnerable. And state/federal assistance is unlikely. (And the other planning assumptions in the ‘National Strategy for Pandemic Influenza’).
So I’m wondering…
…do Joe/Jane public know about this? Or do most of them think (if they think of pandemic flu at all), it will be just like a seasonal flu, only maybe a bit worse and affecting more people? If the answer is door #2, then why prepare…after all, “I’ve probably got enough food in the kitchen cupboard to stretch out for two weeks.” and/or “If it’s really that bad/serious, the government would have told me about it.”
IMO, we in government need to align our messages to be more consistent with the threat. We have done this before – the cold war nuclear attack threat, for example. While only a small percentage of the population did the extreme preparation of building/stocking a bomb shelter, there was not panic. A small percent more households pandemic-prepared will stretch scarce community resources so much further.
Then again, if we don’t align our messages to be more consistent with the threat, we may lose enough people to the virus and collateral deaths that ‘vaccination prioritization’ is a non-issue.
July 23, 2008 at 3:45 pm |
Mel,
The President, HHS, OSHA, Dept of Defense, Dept of Education, NGA (National govenors asscociation), et al have put out messages, held summits, etc.
Few citizens visit government websites.
The news, other places have ignored pandemic. Ohh yea, super volcano or astreroid hit have gotten their own shows but not the pandemic.
I agree with you that either cold war or “all hazards approach” is needed at the grass roots level. H5N1 is just the current suspect – it could be something else.
I hope people are not counting on the government. Government cheese does not fit everyone. All the people who want organic food, “Organic Kosher” or diabetic will be disapointed. Even MREs are high is sodium and may not fit all diets. Though they are fun to play with.
Even *IF* the feds had the food – transportation and delivery is a big issue. BTW food banks and church pantries may close early in a pandemic as donations stop. There have been several blogs about this.
Mel, lastly do not forget “Hope brings about more change than dispair”
Lots of people feel unesy and want change.
Regards,
Kobie
“Hope brings about more change than dispair”
July 23, 2008 at 4:01 pm |
Yes, I think you have it Kobie. The key seems to be finding a way to work with the media to responsibly educate people.
And yes, I do have hope, and believe that preparedness and community resiliency is in the beginning stages of a turnaround – perhaps this is part of the ‘lots of people feel uneasy and want change’ observation.
July 23, 2008 at 4:30 pm |
Comments on comments:
1. Does the public know about flu vaccination priorities? I don’t think the general public knows alot about the pandemic flu much less a response tactic like prioritization of vaccines. We try quite hard to get the word out, but the real deal is that it often doesn’t “stick” when we reach people. Continuing efforts at outreach is the only way to get to people. I think the current marketing strategy says you have to reach somebody seven times before they remember something.
2. General public counting on the government: as I mentioned in the vaccine update post, people should not be counting on the magic pill to be saved. I think the same goes for food. There simply won’t be anyone able to ride in and save the day. Like the first scenario video post says, it’s not a matter of poor planning but a simple matter of demand outstripping supply and resources created by a just in time logistics world.
3. There seems to be a general focus on what the federal government is doing about things. We must remember that all emergencies are local. That will certainly be the case for southeast Idaho during a pandemic. At the end of nation’s supply lines and in a rural area not expecting much from the per capita distribution from feds, southeast Idaho must be dependent on local resources and rely on local government for specific interventions (not necessarily providing resources but managing the event).
4. Non-pharmacological interventions (NPIs) are clearly the most important message we can get out to the public. The key result is flattening the sickness and death curves to minimize the overall impact. Quick recognition of the event and the right decisions made in a timely manner are essential. In southeast Idaho, odds are we’ll be able to see the pandemic start on the east or west coast and move inward towards us (although we have the possibility of bringing it directly from southeast Asia to America beginning in Idaho). Surveillance and quick decisions can flatten the curves here.
July 23, 2008 at 4:31 pm |
In the Domestic Preparedness e-mail update today, there was mention about a hospital preparedness conference. Go to http://www.worldrg.com/showConference.cfm?confCode=HW08075&field=dayone for more information. Looks interesting.
July 23, 2008 at 7:08 pm |
Darin,
Hi. If it is of any help advertisers say ‘people have to see a message seven times before it sticks” so its repatition, repatiion, and then repete.
Sigh, I think you are right about no one knowing the vaccine policy. I’ve been told “its not news yet, when it happens it will get reported.” Unfortunatly that is too late. Way too late for me. I want to work with those who have years of pandemic training, not amatures glued to Google trying to figure out what it is.
We are lucky, very lucky. We are in the western hemispher with alot of technology. We get to learn from other countries struggling and suffering with HN1 long before it gets here. I am sad that only a few people like SDHDtraing, DemFromCT, et al, are doing something.
Darin you are right – emergencies are local. Secretary Leavitt of HHS has said “Do not expect help to arrive” – or words to that effect. That is ok. When Lewis and Clark went west they did not expect help to arrive. During WW-II when Japan bombed Pearl Harbor we did not expect help to arrive. America was already helping our allies. All during the cold war we did not expect help to arrive, we would do it. We would do it. We would do our best.
Mel, if we get it then spread it so others either get or fail of their actions – not ours.
Can we coclude NPIs are the only sure bet and a vaccine is more for wave 2 of the pandmeic?
Regards,
Kobie
“Its your move”
July 23, 2008 at 7:51 pm |
Kobie asks…
“Can we coclude NPIs are the only sure bet and a vaccine is more for wave 2 of the pandemic?”
Not id the virus mutates away from the vax
Not if the vax proves harder than expected to make
Not is the effect of JIT disruptions effects vax production
Not if the distribution of the vax is made impossible due to infrastructure disruptions and lack of fuel.
There was a big focus on keeping the oil flowing which is key to keeping things running. The final vax plan puts that below health care workers and pregnant women.
July 23, 2008 at 7:53 pm |
I think you’re right Kobie. The most realistic scenario we can expect is that a vaccine will not come along for probably six months, by which time the second wave could be upon us. As characterized by the last three pandemics, that tends to be the deadliest wave. In the case of the 1918 Spanish Flu outbreak it is believed to have caused 90% of the total deaths (or as many as 90 million deaths depending who you choose to believe) all in the space of a few months. The numbers of doses that will be available when a vaccine is first made available will be a drop in the bucket, however. Most members of the general public won’t fit the criteria of “mission critical” and need to understand that they will most likely not be at the head of any vaccination lines for quite some time. There will be no magic bullet for this one. The best advice will still be to avoid infection in the first place by practising social distancing, wearing masks, handwashing and even sheltering in place if necessary and feasible. For an extended SIP to be effective though, people need to understand that a stock of essential supplies bought BEFOREHAND is a prerequisite. The problem with getting the message over to the public (and making it stick) seems to be threefold. As a species we have a short attention span – if a pandemic doesn’t appear within a year or so of us being warned we lose interest. It also seems that pandemic flu had it’s 15 minutes of fame in the media spotlight last year, and the media seem unwilling to revisit it just yet. And I also suspect that both media and government are hesitant to be the ones proclaiming that the sky is falling just in case it turns out to be like Swine Flu all over again.
July 23, 2008 at 8:07 pm |
Goju – you make some excellent points. If a major pandemic does hit we may find that everything is disrupted, including the supply chains that feed vaccine production. With a crippled infrastructure we might not see a vaccine in six months as promised. I don’t believe that will be the thing that saves us anyway. Our own response to it – both now and when it hits – will determine whether we survive. Preparing while you can will be the most important thing you can do, because in the throes of a major pandemic we won’t have the luxury of running to the store and finding the full shelves we’ve grown accustomed to.
July 23, 2008 at 11:17 pm |
People aren’t aware of the vaccination priorities, and there are many people who either do not know what a pandemc is or who don’t “believe in” pandemics.
There was a article a few days ago about a PSA that ran in Dayton for two weeks – they’ll be running it in the entire state of Ohio in a few days.
Some of the comments are very interesting.
July 23, 2008 at 11:45 pm |
There were a few comments from people who seemed have some awareness of pandemics, but most were very skeptical. I’ve pulled parts of the comments to give you a sense of where the public is…
medical profession wants you to believe toxic chemicals into your body will help.
This is all about somebody keeping their jobs and funding.
It has been the right wing’s agenda to make the American people afraid of everything, they do this as a control technique
Pandemic flu was the result of illiteracy , poor sanitation and overcrowded cities
The whole thing is crap ! Just take care of your self, avoid crowds, wash your hands
trying to strike fear and panic
there is nothing to worry about if we pray hard enough God will protect us.
What a surprise that this morbid piece of crap is running so close to election to take focus off real issues facing us today and to try and achieve societal paralysis through more fear tactics
the legalized drug pushers disguised as pharmaceutical companies trying to regain some of their lost revenue due to all lawsuits for the drugs they have pushed through that have already caused numerous deaths
THIS IS A RERUN OF THE PAST 2 YEARS
Interesting that they print it in Spanish as well, when most of the illiterate peons who are BRINGING diseases to our country can’t read in their OWN language EITHER!
I am tired of “terror” and “disease” fear atmosphere.
It is a very bad commercial. It completely disregards the fact that in the 51 years since the last “pandemic” we have made numerous advances in medical and social technology. We are cleaner in both personal hygiene and with food preparation, the two biggest factors against any flu.
Should we be all that worried? The poorly cited information on their website isn’t even recent. The most recent “news release” on their site is nearly 2 years old.
This adds up to wasted taxpayer monies. $200,000.00 on a commercial to advertise a disease absent the States and will be prevented due to increased sanitation in years since the outbreak.
Feels like written by a drug co to scare people into getting flu shots,
If you don’t fall in certain groups, flu shots are overkill.
It there news release in the paper they said the electric will go out. When I ask them why it would go out they did not have any answers
Then lift the ban on DDT and get rid of the virus reservoir and transmitting agent,
Here’s the link
http://www.daytondailynews.com/n/content/oh/story/news/local/2008/07/21/ddn072108pandemicweb.html
July 24, 2008 at 6:21 am |
I read through the vax priority plan… it is very good. They really listened. There are contingencies for a very severe pandemic.. 2% and way up… see that black arrow pointing straight up!
They have vax manufacturers in a high priority for severe pandemic.
all in all, I am pleased… for once.
July 24, 2008 at 8:00 am |
Goju, JacksDad,
You make some good points about NPIs looking like the best bet for wave 1 and wave 2. H5N1 mutates, vaccine effectiveness will not be known till after it is used in mass. Trials are good but only tell part of the story.
After watching yesterday’s “Live Response” webcast the first responders could be small chicken farms. If h5N1 comes in on a bird instead of a plane that changes points of infection, quranteen rules, who are first responders, who/what is tracked, the equipment needed, econominc and social impacts.
The 8 hour AI course is offered for free, *FREE*, as long as you have 25 or more students. Yes there are hands on parts using PPE and euthanasia equipment.
Goju, I agree we need to keep the grid up. I’m not sure how rigid the vaxccine distribution plan is. I hope multiple scenarios are played out so we are not behind the learning curve.
Aurora – very good find. It helps us to know what public opinions doctors, public health and preparation folks are fighting. There will be people who opt not to get vaccinated. Forced vaccinations sound good but have generated alot of resistance in democratic countries. North Korea and China may pull it off.
Sadly you are right. Alot of PSA stuff is two years old. Last years HHS pandemic blog generated interest by the Ad council but no results.
Note: when people say we are fighting a disease that has only affected a few hundred “over there” I reminde them that that is how HIV started out. it only affected a few hundred over there in Africa. I only affected a few hundred over there in France or europe. If HIV had been eradicated over there it would not be world wide now.
I also remind them of how they buy winter coats in the summer to prepare for the winter. They buy umbrellas when the sun is shining. They see a doctor before they get sick.
The vaccine manufacturing plants are where?
Regards,.
Kobie
“The time to fix a leaky roof is when the sun is shining” J.F. Kennedy
July 24, 2008 at 8:32 am |
I see so much anxiety and dispair.
It seems natural that people would do things to prepare, be informed.
They just dont unless there is some incentive.
I am thankful that we , others, have forthought, interest and ability to place plans into place.
Great information
July 24, 2008 at 12:18 pm |
Laqueta,
Can you expand on the anxiety and dispair?
These same people who feel they can do something about global warming are not sure they can do somethign about H5N1?
These same people who feel they can do something about world hunger or the killing in Dafur are not sure they can do somethign about H5N1?
I would like to know more. Please tell me.
Regards,
Kobie
“Men are born to succeed, not fail.” Henry David Thoreau (1817 – 1862)