|Implemented in this survey?|
Anticipating a resurgence of novel influenza A (H1N1) cases while at the same time targeted H1N1 vaccines become available in limited quantities in the United States, the Centers for Disease Control and Prevention (CDC) issued recommendations for priority groups in the circumstance that vaccine quantities do not suffice to inoculate all interested individuals.
In June 2009, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) composed recommendations for the allocation of vaccine against a new influenza A (H1N1). The seasonal influenza vaccine is currently available but does not protect against H1N1, and sufficient H1N1 vaccines may not be available immediately to inoculate all interested individuals.
The United States ordered 195 million doses of H1N1 vaccine from five companies: MedImmune, a unit of AstraZeneca, Sanofi-Aventis, Australia's CSL, GlaxoSmithKline and Novartis. Early results of H1N1 clinical trials suggest both adults and children will be protected by a single 5-microgram dose of the 2009 H1N1 influenza vaccine, much like the seasonal flu shot. Children may need two doses.
The first H1N1 vaccines were expected to be made available to the public in early October 2009. In the event that insufficient vaccines were immediately available, the CDC identified five population groups that ought to be given priority access to the vaccine. These groups have the highest risk for infection or influenza-related complications according to epidemiological data from the initial phase of the H1N1 epidemic in spring of 2009. The committee recommended that providers try to first vaccinate (order not indicating priority):
These priority groups comprise approximately 159 million people in the United States. Once local priority group vaccination needs have been met, ACIP recommends vaccines be made available to people aged 4-24 years , then adults aged 25-64 years, and lastly adults over 65 as these individuals show some existing immunity to H1N1 influenza. State and local health officials and providers are expected to make decisions about expanding vaccination priorities based on local cirumstances.
These recommendations are purposefully broad to accommodate local variations in need and demand. State and local health departments may provide additional guidance. In the absence of any state and local guidance providers have been instructed to vaccinate individuals in the initial target populations on a first-come, first-served basis. No federal requirement exists for documenting priority group status or penalizing providers who vaccinate outside the priority groups. Some localities have mandated that health care workers receive the H1N1 vaccination, but the federal H1N1 vaccination program is voluntary.
The United States military has also created priority groups for their mandatory H1N1 vaccination campaign. All active duty military personnel, National Guard troops on active duty, and civilian Defense Department employees with critical jobs will be vaccinated. Roughly 1.4 million vaccines will go to military personnel, beginning with 1) troops preparing to deploy, 2) other active-duty forces, particularly any who might be needed to quickly respond to a hurricane or other emergency. The vaccine will also be made available to the families of military staff.
The main principle of the federal recommendations for H1N1 vaccination is to vaccinate as many people as quickly as possible. As such, the recommendations aim to first meet the need and demand for vaccination in the populations at highest risk for infection from H1N1 or serious complications upon becoming infected. A secondary objective is to vaccinate critical workers should the epidemic reach crisis levels, e.g. health care workers and military personnel.
No incentives other than the protection the vaccine confirms are being offered.
Health-care and emergency medical services personnel who have direct contact with patients or infectious material, military personnel, pregnant women, persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, daycare providers), children aged 6 months-4 years, children and adolescents aged 5-18 years who have medical conditions that put them at higher risk for influenza-related complications
|Medienpräsenz||sehr gering||sehr hoch|
The recommended vaccine priority groups are fairly consensual, having evolved out of similar priority group recommendations from WHO and prior U.S. influenza pandemic planning efforts. However, if followed, they will substantially impact which individuals are able to receive an H1N1 vaccination and when. Moreover, a non-tiered system like that proposed by ACIP will only work if sufficient vaccines are initially made available.
The CDC recommendations for vaccination priority groups stems from a series of steps the federal government has taken in preparing for the anticipated resurgence of H1N1 in the fall of 2009. While generally not mandatory, the recommendations prioritize protection of those individuals most vulnerable to H1N1 influenza and critical workers.
Health risk due to the pandemic threat
|Implemented in this survey?|
After the H1N1 pandemic was declared in spring 2009, the U.S. Department of Homeland Security and Department of Health and Human Services tasked the National Vaccine Advisory Committee (NVAC) and the Advisory Committee in Immunization Practices (ACIP) with providing recommendations on vaccine prioritization by modifying pre-pandemic planning guidance from 2006 and earlier according to the H1N1 epidemiologic and clinical data and the projected vaccine supply timeline.
The approach of the idea is described as:
renewed: The priority groups identified by the U.S. were also identified by the World Health Organization and are similar to those used globally in pandemic planning over the past decade.
The recommendations as currently formulated are voluntary and do not involve a tiered system, such that all members of priority groups theoretically have equal access to the first available vaccines. As such the priority group recommendations are fairly uncontroversial.
|Centers for Disease Control and Prevention||sehr unterstützend||stark dagegen|
|Food and Drug Administration||sehr unterstützend||stark dagegen|
|State government||sehr unterstützend||stark dagegen|
|Health care workers||sehr unterstützend||stark dagegen|
|Privatwirtschaft, privater Sektor|
|Vaccine manufacturers||sehr unterstützend||stark dagegen|
|World Health Organization||sehr unterstützend||stark dagegen|
The proposed recommendations do not require legislation.
|Centers for Disease Control and Prevention||sehr groß||kein|
|Food and Drug Administration||sehr groß||kein|
|State government||sehr groß||kein|
|Health care workers||sehr groß||kein|
|Privatwirtschaft, privater Sektor|
|Vaccine manufacturers||sehr groß||kein|
|World Health Organization||sehr groß||kein|
When the first H1N1 vaccines become available, state and local health department officials and health care providers are expected to distribute the vaccines. Providers have been instructed to meet the demand for vaccine on a first-come, first-served basis among persons in the initial target groups, followed by all persons age 25 through 64, followed by all persons aged 65 and older. Neither incentives nor punitive measures have been proposed to ensure these recommendations are followed at a local level.
No monitoring or evaluative mechanism has been discussed for the recommended H1N1 vaccination priorities.
It is plausible that providers and health officials will adhere to vaccinating individuals within the recommended priority groups before the rest of the public, particularly if a limited number of vaccines are initally available or large numbers of individials seek vaccination. However, without oversight or regulation it is also plausible that providers will vaccinate all interested individuals on a first-come, first-served basis, regardless of whether the individual belongs to a priority group population.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The vaccine priority group recommendations could fundamentally change the effects of the H1N1 pandemic if followed. Vaccination of the highest risk groups first could prevent or reduce H1N1-related disease burden on medical facilities.
Krista Harrison and Gerard Anderson