Federal Government Considering Limiting H1N1 Flu Vaccine to Those At Highest Risk
At a Senate hearing yesterday, the CDC, the U.S. Department of Health, and the Department of Homeland Security were criticized by Senator Joseph Lieberman, Chairman of the Senate Homeland Security & Govermental Affairs Committee, as well as by other committee members for allowing the states to decide how to best distribute the H1N1 flu vaccine. State plans for distribution of the vaccine were developed based upon the assumption that 120 million doses of the vaccine would be available by mid-October. The states developed plans to distribute the vaccine first to high priority individuals, which the federal government estimated to be 169 million people. Since typically only 30 percent of the population chooses to receive the seasonal flu vaccine, the assumption was that there would be enough vaccine to give it those individuals in the high priority group who wanted it. In fact, however, there was only approximately 28 million doses of the vaccine available by mid-October. Despite this, the federal government and the states did not change their plans so as to give priority to what had been previously identified as an even smaller super priority group. This group consists of approximately 42 million individuals, and includes those individuals with underlying health conditions that complicate their getting the H1N1 swine flu – and which have had the highest percentage of deaths. Unfortunately, since federal and state plans had targeted the larger 169 million group and only 28 million doses of the vaccine were available, this resulted in a large number of the super priority group at the greatest risk of death being unable to get the vaccine – while other individuals at a significantly less risk were able to receive the vaccine. Committee members highlighted the example of employees of Goldman Sachs receiving the vaccine in New York City while there was no plan to target the super priority individuals that needed the vaccine the most. Committee members also highlighted the example of the City of San Francisco where a random lottery method was being utilized to determine who would receive the vaccine, instead of the vaccine being given first to the super priority group of individuals at the greatest risk of death from the H1N1 swine flu. Criticism by committee members of the lack of a federal approach that would target those individuals at the greatest risk first poses the potential that the federal government will take a stronger approach and require the states to modify their H1N1 swine flu vaccination programs. Another criticism of committee members related to the lack of planning by the federal government to insure that there was flu vaccine production capabilities by U.S. manufacturers. Instead, four of the five manufacturers of the H1N1 swine flu vaccine are overseas manufacturers. This resulted in Australia and Canada stepping in and telling the manufacturers located in their countries that they were prohibited from sending the vaccine to the U.S. until their domestic demand for the vaccine was satisfied. This is one of the reasons that the U.S. received such a signficantly reduced amount of vaccine than it had anticipated. As such, committee members criticized the federal government for not anticipating that other countries might demand that their manufacturers supply their domestic demand before allow the exportation of the vaccine to the U.S. The primary criticism of committee members, however, about the failure of the federal government and the states to modify their priorities about who could receive the H1N1 swine flu vaccine once it was realized that a signficantly reduced amount would be available - and thus the failure of the federal government and the states to live up to their promises that the greatest risk individuals would receive the vaccine first. Unfortunately, as it came out at the Senate hearing, the target group for the vaccine has been a larger group of 169 million (based upon the assumption that a larger amount of vaccine would be available) as opposed to the 42 million individuals at the greatest risk, with the result that many if not most of the 42 million highest risk individuals have not been able to receive the vaccine.
