ROCKVILLE, MD. — Should the United States face an influenza pandemic, the federal government should buy all the vaccine, members of the National Vaccine Advisory Committee agreed at a joint meeting with the Advisory Committee on Immunization Practices.
The committees met to review the work of the Pandemic Influenza Working Group and vote on several points in the Department of Health and Human Services' current draft Pandemic Influenza Preparedness Plan.
During deliberations of the National Vaccine Advisory Committee (NVAC), members preferred the government vaccine purchase option over three others, including the current standard purchase of vaccines by a mix of public and private groups. However, they emphasized that the universal government vaccine purchase applied only in the event of a pandemic.
The NVAC also voted to accept the recommendations of the working group's antiviral subgroup. These recommendations included creation of an antiviral drug stockpile sufficient to reduce the public health impact of a flu pandemic. At least 40 million courses of antiviral drugs are needed to provide critical response support in the event of a pandemic, said Andrew Pavia, M.D., of the University of Utah, Salt Lake City, who presented the recommendations.
The NVAC voted that oseltamivir should be the primary drug stockpiled for a flu pandemic, with zanamivir stockpiled as a backup. Although vaccination is the most formidable weapon against a flu pandemic, antiviral drugs are effective when used early in the disease if vaccines are not available, Dr. Pavia noted.
In addition, NVAC members voted to accept the recommendation of the antiviral subgroup on the approximate numbers of drug courses needed for priority target groups including hospitalized patients, health care workers with direct patient contact, pandemic health responders, public safety officials, and government decision makers. They also approved the subgroup's recommendations that additional research to support the use of antivirals in the event of a flu pandemic should include the safety of oseltamivir in infants less than 1 year of age, the sensitivity of rapid diagnostic tests for flu strains with pandemic potential, such as H5N1, the impact of antiviral treatment of a flu pandemic on hospital admissions, the testing of an optimal treatment dose and schedule in a ferret model with H5N1 and other flu strains, and the investigation of the potential for use of other antiviral agents.
The NVAC and the Advisory Committee on Immunization Practices (ACIP), both of which advise the Centers for Disease Control and Prevention, also met jointly and voted in favor of a “prioritization table” of people who would be the first to receive vaccines in the event of a flu pandemic.
The supply of vaccine will likely be limited, and identification of priority groups will help decrease the overall health impact of a pandemic while limiting economic disruption and reducing the overall societal impact, said Ben Schwartz, M.D., of the National Vaccine Program Office at the Department of Health and Human Services. The draft prioritization table, created by the Joint ACIP/NVAC Working Group on Pandemic Influenza Vaccine Prioritization, established four tiers.
Tier 1 is subdivided to include persons with direct patient contact and critical support staff, patients in the highest risk group based on the standard ACIP criteria, household contacts of children younger than 6 months, pregnant women, and critical government leaders and pandemic responders.
Tier 2 includes other high-risk patients, followed by those in critical community infrastructure, such as public health emergency responders, public safety, utility, and telecommunications workers.
Tier 3 includes other important government health care decision makers, and mortuary service personnel.
Tier 4 includes healthy people aged 2–64 years who are not in any other group.
“We in clinical care need to have very explicit guidelines as to which patients can be identified upfront [for vaccine priority] by the use of things like administrative databases, coding, and demographic information,” commented Jonathan Temte, M.D., the American Academy of Family Physicians' liaison to ACIP.
“We need to develop lists now that correspond to the priority groups, rather than trying to do that on the fly,” he said. Explicit definitions given to those in charge of clinics can avoid disruption with staff over situations such as, “you work in the file room, so you don't get a shot.”
The draft of the Pandemic Influenza Preparedness Response Plan has been sent to the Department of Health and Human Services for review, with additional revisions possible later this year.
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