Who should receive vaccines and antiviral drugs in the event of a flu pandemic?

Since flu vaccine and antiviral drugs are in scarce supply, the WHO recommends that all nations determine in advance which groups of people will be the first to receive these treatments in the event of a flu pandemic. But a new study in PLoS Medicine finds that 30% of nations have prioritized neither vaccine nor drugs in their pandemic influenza preparedness plans.

In the first study of its scale, Lori Uscher-Pines and colleagues from the Johns Hopkins Bloomberg School of Public Health, and the Ben-Gurion University of the Negev, Israel, analyzed 45 national plans from both developed and developing countries. Plans from all regions of the world were represented in the analysis.

Of the national plans identified, 49% prioritized which groups in society would receive antiviral drugs while 62% prioritized which groups would receive flu vaccine. This is an unexpected finding, say the authors, since antivirals may be the first--and, perhaps, the only--pharmaceutical intervention available to many countries in a pandemic.

"Because it is estimated to take six months to mass produce strain-specific vaccine," they say, "and global antiviral production and stockpiling is increasing, priority setting for antivirals may prove to be more critical to pandemic preparedness."

The researchers found that that the allocation decisions varied across different countries. While health-care workers were consistently ranked at the top of the vaccine and antiviral priority lists, there was then a wide variation between countries in their choice of who would be next in line (e.g. elderly, children, essential service workers).

One striking finding was that of the nations that prioritized who would receive vaccine in a flu pandemic, almost half prioritized children, even though the WHO states in its guidelines: "There is no evidence that use of inactivated vaccine in children will reduce the spread of a pandemic in the community, and this strategy is not recommended" (http://www.who.int/csr/resources/publications/influenza/11_29_01_A.pdf).

The authors conclude that "attention to prioritization and its ethical implications may help to reduce death and disease burden, and minimize political destabilization and claims of injustice."

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The study "Priority setting for pandemic influenza: an analysis of national preparedness plans" was co-authored by Saad B. Omer, Thomas A. Burke, and Daniel J. Barnett from the Johns Hopkins Bloomberg School of Public Health, and Ran D. Balicer from the Ben-Gurion University of the Negev.

Citation: Uscher-Pines L, Omer SB, Barnett DJ, Burke TA, Balicer RD (2006) Priority setting for pandemic influenza: An analysis of national preparedness plans. PLoS Med 3 (10): e436.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030436

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About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org

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