Thursday, December 20, 2007

Draft guidelines issued by the United States Department of Health and Human Services in November have established a series of tiers and categories for distribution of scarce vaccine in the event of pandemic flu. These guidelines give strong preference for emergency responders, military and national security personnel, and socially important occupations, such as top politicians, energy sector and communications personnel, bankers, and newborn infants. Distribution of vaccine to the elderly occupies a low priority, especially in the event of a severe pandemic with a case-fatality rate of 2% or more causing more than 1.8 million deaths. The scheme differs significantly from that proposed in Britain in 2005, which gave high priority to the elderly, noting that most of the deaths in recent years – ranging from 12,000 to 29,000 annually – were in elderly patients.

U.S. 2007 Britain 2005
Tier 1. Deployed/mission critical national security, health care providers, police, fire, vaccine manufacturers, top politicians Priority 1. Health care workers, nursing home staff
Tier 1*. Pregnant women, infants (*Sub-tier plan places at lower priority than other Tier 1) Priority 2. Fire, police, security, communications, utilities, undertakers, armed forces
Tier 2. Intelligence, border, national guard, other domestic national security, community support, electricity, natural gas, communications, water, critical government personnel, children, household contacts of infants Priority 3. High medical risk (e.g. diabetes, immunosuppressed)
Priority 4. All over 65 years of age
Tier 3. Other active duty military, important health care, transport, food, banking, pharmaceutical, chemical, oil sector personnel, postal and other government, children Priority 5. Selected industries, e.g. pharmaceuticals
Tier 4. High risk conditions, all over 65 years of age Priority 6. Children
Tier 5. General public Priority 7. General public

The plan is open to public comment under U.S. Federal Register guidelines until December 31.