pandemic influenza vaccine prioritization: rationale and process pandemic influenza vaccine: doses...
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Pandemic Influenza Vaccine Prioritization:Rationale and Process
Pandemic Influenza Vaccine: Doses Administered and Safety Training Conference
Tom Shimabukuro, MD, MPH, MBAImmunization Services Division
Centers for Disease Control and Prevention (CDC)
August 21, 2008
Goal
• The goal of the pandemic influenza vaccination program is to vaccinate all persons in the U.S. who choose to be vaccinated
• However:– Vaccine supply will not be available all at once– Decisions on who will be vaccinated first will have to be made– Overarching objectives are to reduce the impact on health
and minimize disruption to society and the economy
2005 ACIP/NVAC recs
http://www.pandemicflu.gov/vaccine/allocationguidance.pdf
Process
• Federal interagency working group meetings/discussions (co-led by DHS and HHS)
• Historical analysis of previous pandemics• Public engagement and stakeholder meetings• Formal decision analysis process
Specific objectives
• Protecting those who are essential to the pandemic response and provide care for persons who are ill
• Protecting those who maintain essential community services
• Protecting children• Protecting workers who are at greater risk of
infection due to their job
General principles and guidance
• Takes into account “pandemic severity index” (PSI)
• Pro rata allocation• Recommend state and local governments
follow national recommendations• Epidemiology of the pandemic will determine
if modification of recs is necessary• Guidance will be reassessed periodically
Framework
• Categories– Homeland and national security– Health care and community support services– Critical infrastructure– General population
• Target groups: specific occupations / occupational groups
• Tiers (1-5)
The following slides are courtesy of Ben Schwartz, MD
HHS/NVPO
Vetting the draft guidance with the public Vetting the draft guidance with the public and stakeholdersand stakeholders
• Presentations to ACIP and NVAC
• Public engagement meetings
– Milwaukee, WI
– Hendersonville, NC
• Stakeholders meeting
– Washington, DC
• Web dialogue
• Request for comments posted in the Federal Register and at www.pandemicflu.gov
Outcomes of vetting process with the Outcomes of vetting process with the public and stakeholderspublic and stakeholders
• From public engagement and stakeholders meetings, and web dialogue
– Votes of participants
• On general agreement with goals and guidance
• On suggested potential changes
– 7-point scale from strongly agree to strongly disagree
• From request for comments in the Federal Register and at www.pandemicflu.gov
– 124 written suggestions from organizations and individuals
Overall agreement with the guidance by Overall agreement with the guidance by the public and stakeholdersthe public and stakeholders
Polling results
(% Agree to Strongly Agree)
Milw Hend Web Stake
Overall agreement with goals of the guidance
93% 74%
Agree with targeting children before older adults
82% 91% 76% 83%
General agreement with draft guidance
58% 79% 80% 83%
Changes considered at public & Changes considered at public & stakeholders meetings: stakeholders meetings:
General PopulationGeneral Population• Supported
– Prioritize healthy adults before ill or elderly
– Move very elderly or incapacitated to Tier 5
– Prioritize children 3-18 before infants and toddlers
• Neutral
– Prioritize parent or healthy head of household (32.5 M households with children <18 yrs old)
• Opposed
– Prioritize persons in communal settings – prisoners, nursing home residents, homeless
Suggestions from written comments: Suggestions from written comments: General PopulationGeneral Population
• Describe priorities if mortality during the pandemic were highest in young adults (“W” shaped curve as in 1918)
• Target healthy adults before ill and elderly
• Vaccinate parents before children (to care for them)
• Sub-prioritize among healthy adults
– “Farmer before fry cook”
– Employed before unemployed
– “Gifted” persons first
Should family members of HCWs & emergency Should family members of HCWs & emergency services workers be targeted?services workers be targeted?
• Concerns with targeting household or family members
– Adds substantially to size of targeted population
– Unclear whether truly needed to avoid absenteeism
– Other protective measures may be used
– Raises equity concerns
Group Number
Additional persons
Household (x1.6) Family (x2.2)
Healthcare 7.4 M 11.8 M 16.3 M
Emergency serv. 2.0 M 3.2 M 4.4 M
Suggestions from vetting process: Suggestions from vetting process: Government WorkersGovernment Workers
• Every meeting strongly agreed with moving politicians to their Gen. Pop. group (i.e., T4 or 5)
– Voting results (Agree/disagree): Milw: 77%/15%, Hend: 79%/16%, Web: 85%/8%, Stakeholders: 63%/33%
• Several comments suggested the same
– “Politicians, those cheerleading panderers who are useless in an emergency, should be stuck at the bottom with the rest of us.”
The findings and conclusions in this presentation have not been formally disseminated by CDC and should not be construed to represent any agency determination or policy.
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