Sunday, July 12, 2009

U.S. Prepared to Spend Billions on Swine Flu Vaccine

Students 1st in Line For Flu Vaccine

Mass Campaign Against Pandemic May Begin in Fall

By David Brown and Spencer S. Hsu

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School-age children will be a key target population for a pandemic flu vaccine in the fall, and they may be vaccinated at school in a mass campaign not seen since the polio epidemics of the 1950s.

The federal government should get about 100 million doses of vaccine by mid-October, if the current production by five companies goes as planned. But enough vaccine for wide use by the 120 million people especially vulnerable to the newly emerged strain of H1N1 influenza virus will not be available until later in the fall.

Those were among the messages administration officials delivered to about 500 state, territorial, city and tribal health officials yesterday at a "flu summit" at the National Institutes of Health's Bethesda campus.

President Obama, speaking by audio link from the Group of Eight summit in L'Aquila, Italy, urged "complete ownership" of preparations for what he termed a "significant outbreak" of H1N1 flu in the next few months.

"We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation," he said. He added that "the most important thing for us to do is to make sure that state and local officials prepare now to implement a vaccination program in the fall."

Children, pregnant women, adults with chronic illnesses, and health-care workers would probably be first in line for the vaccine, Health and Human Services Secretary Kathleen Sebelius told the gathering.

Education Secretary Arne Duncan said "we would absolutely welcome" the idea that the nation's schools be a principal venue for delivering the vaccine. He called them "natural sites" and said that "to open our doors and be part of the solution really makes sense."

In recent years, some public school systems have offered seasonal flu vaccine to students. But there have been no school-based mass campaigns since the late 1950s, when a generation of children lined up to get the Salk polio vaccine. How a 21st-century effort might be accomplished is an urgent priority of this summer's pandemic planning.

Vaccination campaigns, wherever they are held, would be mainly run by local governments.

To help them make specific plans, Sebelius said the federal government will provide an additional $350 million, to be disbursed by the end of this month. About $260 million will go to states and territories, with the remaining $90 million to hospitals to help preparations for a likely surge of flu patients in their emergency rooms and intensive care units.

The federal government has spent about $1 billion so far on pandemic flu vaccine, with about $7 billion available for further purchases and other pandemic countermeasures.

The new H1N1 virus, derived from two strains of influenza virus that circulates in pigs, emerged in late April in Mexico and Southern California. Still called "swine flu" by many people, it is now in every state. More than 1 million Americans have become ill from it, and 170 have died. Worldwide, it is on every inhabited continent and is responsible for at least 420 deaths.

Unlike seasonal flu, which typically strikes the elderly most severely, the new strain disproportionately attacks children and young adults. In New York City, of the 47 deaths that occurred through yesterday, 44 were people younger than 65. That trend, however, will pose unusual challenges to the American medical system, as many teenagers and young adults rarely visit doctors or clinics.

Patricia O'Neill, vice president of the Montgomery County Board of Education, said last night that she would have no objection to a school vaccination program if health officials deem that to be the best response.

As both a parent and as an official, she said, her chief concern is the health and safety of children. "No one wants their child sick and no one wants their child to die," she said.

Tanzi West, spokeswoman for Prince George's County schools, also supported the plan.

"Anything that protects students and families should be applauded," West said. She added that the school system already provides vaccinations for students through the county's health center.

A topic of much discussion at yesterday's summit was what circumstances should trigger the closing of schools.

Federal health officials in April gave conflicting guidance to schools with suspected cases, initially recommending that they close for 14 days before judging, based on additional information, that it was enough for infected persons to stay home.

New York had one of the earliest outbreaks this spring and closed 55 schools for as many as seven days, with none experiencing a resurgence of the illness when they reopened. Elsewhere, however, the benefit of closing schools was less apparent.

Meanwhile, the closures presented "tremendous hardships," O'Neill said, both in missed instruction and in added stress for affected families. One school in her district, Rockville High School, closed for three days in early May after one student contracted the flu. "You can't make up that time for students very easily," O'Neill said.

Moderating a panel yesterday that included the video appearances of the governors of Maine, Vermont, Connecticut, Wisconsin and Kansas, Maryland Gov. Martin O'Malley (D) said that he found less than helpful the federal guidance that governments "should consider" closing a school if flu becomes widespread. "We're all considering it," he said tartly.

It now seems clear that closing schools purely to limit the spread of the virus will not be recommended if the communicability becomes no more severe than it is now.

"One of the things I think we learned is that school closure as a means of decreasing transmission will only be effective if we have systems in place to support people doing the right thing," said Richard E. Besser, who was acting head of the Centers for Disease Control and Prevention for the first two months after the emergence of the new virus.

If parents are unable to stay at home with children and instead leave them in libraries, malls and community centers, where people tend to gather in large numbers, then "you're not really doing anything," he added.

Only if the virus became much more deadly would a strategy of closing schools to promote "social distancing" be strongly recommended, said Thomas R. Frieden, the new CDC director. He told the gathering that "our goals at the moment are fairly straightforward: reduce illness and minimize social disruption."

Why elderly people appear to be largely escaping this flu outbreak is unknown. There is some evidence that older adults may be at least partially immune to this H1N1 strain because of exposure to a distantly related strain earlier in life.

But Anne Schuchat, a CDC physician helping to lead its pandemic response, said that "we are not imagining we'll get 100 percent coverage of any one group" in a vaccination campaign.

Before any vaccine is given to the public, however, it must be proved safe and effective and the proper dose must be determined in tests this summer. People will probably need to get two doses at least several weeks apart to be protected.

The vaccine supply, which could ultimately total between 200 and 300 million doses, will be acquired by the federal government, which will then distribute it to states, territories, cities, tribal governments and federal agencies.

"We may recover some of the costs from private insurers," Sebelius said, but added, "This will be a public effort funded by the federal government."

State and local officials wanted the Obama administration to galvanize elected leaders around the country to prepare for the fall, and praised the participation yesterday of three Cabinet secretaries and five governors and the commitment of federal grants.

"It's one thing to say something. It was another thing to demonstrate it beyond words," said Paul E. Jarris, executive director of the Association of State and Territorial Health Officials, who expected many states now to hold their own summits.

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