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Federal Advisory Groups Recommend Priorities for Vaccination and Antivirals During a Pandemic

By Jennifer Nuzzo, S.M., August 2, 2005

On July 19, 2005, the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP) held a joint meeting to make additional recommendations to the draft Department of Health and Human Services (HHS) Pandemic Influenza Preparedness and Response Plan. In development since 1993, the plan was released in draft form on August 26, 2004, and a final plan is expected by August 1, 2005.

The two committees voted on priorities for distribution of limited supplies of influenza vaccine and antivirals and made recommendations for the role of the federal government with regard to purchase of vaccine in the event of a pandemic. The committees considered available epidemiological data, recommendations from bioethicists and stakeholder groups (e.g., medical and healthcare organizations, vaccine manufacturers, public health and patient advocacy groups), and current estimates of stockpiles and production capacities.

Ultimately, it was recommended that the following groups receive vaccine as it becomes available during a pandemic, in the order listed in the table below.

Priority Groups

Approximate Number

Priority

Group 1

A

Health care workers (HCWs) providing direct patient care, essential healthcare support personnel

9 million

Key influenza vaccine and drug plant employees

40,000

B

High-risk patients over age 65 with a chronic condition that increases the risk of a severe influenza infection, patients aged 6 months to 64 years with two such chronic conditions, and people hospitalized in the past year with influenza, pneumonia, or a chronic condition

25.8 million

C

Pregnant women and people in a household with infants or severely immune-compromised patients

10.7 million

D

Key government leaders and critical public health pandemic responders

151,000

Priority

Group 2

A

All seniors, anyone with a chronic condition, and children aged 6 to 23 months

59 million

B

Other public health emergency responders and critical infrastructure personnel, including utility and some transportation workers

8.5 million

Priority Group 3

Key government health decision-makers and funeral home workers

500,000

Priority

Group 4

Healthy individuals aged 2 to 64 years

180 million

The advisory committees also made the following additional recommendations:

  1. The federal government should purchase all influenza vaccine during a pandemic.

  2. Antiviral drugs in quantities sufficient for responding to a pandemic should be stockpiled: 133 million courses to treat all who are infected and to provide prophylaxis for HCWs and patients at highest risk of infection (40 million courses is the minimum that would support critical pandemic responses).

  3. Oseltamivir should be the primary drug stockpiled; Zanamivir should be stockpiled for use against oseltamivir resistant viruses. Zanamivir may be the preferred drug for pregnant women.

  4. If antiviral supplies are limited, treatment and prophylaxis during a pandemic should be prioritized as follows:

    1.  Treat patients hospitalized with influenza

    2.  Treat HCWs with direct patient contact and EMS workers

    3.  Treat pandemic health responders, public safety and key government decision makers

    4.  Treat other high risk outpatients

    5.  Provide post-exposure prophylaxis in certain environments (e.g., nursing homes)

    6.  Provide prophylaxis for EMS and HCWs and in emergency rooms, ICUs, and dialysis units

    7.  Treat outpatients

    8.  Provide prophylaxis for highest risk outpatients

    9.  Provide prohylaxis for other HCWs with patient contact

The advisory committees acknowledged the importance of, but did not make any recommendations regarding the outstanding issues of vaccine liability, stockpiling of syringes and other medical supplies needed for a pandemic response, and distribution of vaccines and antivirals during a pandemic.