WASHINGTON - First, people were clamoring for H1N1 vaccines, but there were not enough to go around. By the time vaccines were available in any quantity, most of the public had lost interest.
And no one knew just how unpredictable the production of vaccines would turn out to be, top U.S. public health leaders agreed on Friday.
Getting the U.S. public to roll up their sleeves and get vaccinated was definitely one of the biggest challenges to managing the pandemic of H1N1 swine flu, speaker after speaker agreed at a conference on influenza regrets.
"The truth is for this pandemic we had about the longest warning we might ever have for a potential biothreat," said Dr. Nicole Lurie, who heads preparedness at the Health and Human Services Department.
"And yet we all lament how long it took for vaccine to be made," she told the conference, sponsored by the Center for Biosecurity at the University of Pittsburgh Medical School. (This is an excellent argument for why the US Government should not be putting its pandemic response money into vaccines: they are too uncertain and take too long to be manufactured and tested. As I testified to the Committee on Government Reform in 2001, a smarter way to respond is to identify the virulence factors from known pathogenic microorganisms and develop drugs and monoclonals in response to them--producing a generic supply of remedies ahead of time--Nass)
... First, vaccine makers had trouble growing the virus. Then there were problems getting vaccines into vials and shipped. And, experts told the meeting, other problems popped up.
The CDC says that by February 13, as the pandemic waned in the United States (the truth is, according to CDC, the pandemic peaked in late October and waned thereafter; on February 13 the rate of positive flu specimens was less than 2% the rate at the October peak--Nass), only 97 million H1N1 vaccine doses had been given to 86 million people in the United States, or 78 percent of doses shipped... ("In mid February, Health and Human Services Secretary Kathleen Sebelius estimated that 70 million Americans had received the vaccine so far... the CDC added that the precise number of doses that have been administered is not known." Yet CDC has a weekly tally of exactly how many doses were given, but they won't admit it--Nass)
Further complicating things -- the United States uses five suppliers, each of whom made vaccine in a slightly different way. MedImmune's nasal spray was great for children but inappropriate for high-risk adults and some of the shots were not indicated for young children.
The CDC and HHS had to patch together an ad hoc network of private manufacturers, a private distributor and numerous retail clinics, hospitals, doctor's offices, employers, state and city health departments.
And Americans were on their own to decide if and when to get vaccinated.
"Our colleagues in the U.K. said no problem -- we just tapped into the electronic health records," Frieden said. They were able to identify patients with high-risk conditions and invite them to come in and be vaccinated by appointment.
And then there were the rumors the vaccine was not safe. "We can't ever be in a situation again where we have a countermeasure that half the public won't accept," Lurie said. (This article sounds like a segue into mandatory pandemic vaccines--stay tuned--Nass)
UPDATE: Dr. Lurie was the person responsible for swine flu vaccine procurement, though she lacked experience in this area. Her last statement can be read two opposite ways: she may be saying we have to do a better job getting a proven safe and effective vaccine to the public more quickly... but since she was the person who got it to the public late with little testing, it is more likely she is saying that next time, she'd prefer the public be required to "take it and like it."
Saturday, March 6, 2010
Posted by Meryl Nass, M.D. at 10:28 AM