Why the bird flu must spread.

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http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/mar2008panupdate.\html

[13 miilion vaccines for a disease that unfortunately refuses to become an epidemic. What will happen to all those who have invested in the bird flu?]US has enough H5N1 vaccine for 13 million peopleMar 20, 2008 (CIDRAP News) – A progress reportreleased today says the US government hasstockpiled enough prepandemic H5N1 influenzavaccine for 13 million people, more than doublethe number listed in the previous report, issued last July.The report on pandemic preparations by theDepartment of Health and Human Services (HHS)also says the government plans to release a newversion of its pandemic vaccine allocation planin coming months, after considering comments at aseries of recent meetings and forums.The 16-page report from HHS Secretary MikeLeavitt lists a wide range of HHS pandemicpreparations. It emphasizes the agency's effortsto collaborate with other

stakeholders intackling problems like vaccine allocation and whoshould bear the burden of stockpiling suppliessuch as face masks, respirators, and antiviraldrugs. The report is the fifth in a series that began in March 2006.Concerning the H5N1 vaccine, the report says, "Bythe end of 2007, HHS had purchased and stockpiled13 million courses of pre-pandemic vaccine." Theprevious report, issued in mid-July, said theagency had acquired 12 million doses of thevaccine, enough for 6 million people.The vaccine, based on a clade 1 virus isolatedfrom a Vietnamese patient in 2004, was approvedby the Food and Drug Administration in April2007. Although no one knows how well it wouldwork against an emerging pandemic strain of H5N1,HHS officials hope it would provide someprotection to those most at risk for exposure inthe early months of a pandemic.The report also says that HHS has

acquired enoughantiviral drugs to treat 40 million people, orabout 80% of the agency's goal of 50 million.Officials want the states to buy enoughadditional doses with the help of a 25% federalsubsidy to treat another 31 million people. Thereport does not specify how many courses thestates have bought but says that many havepurchased "the full subsidized amount or more."The Centers for Disease Control and Prevention(CDC) recently told CIDRAP News that the federalantiviral stockpile has reached 39.8 milliontreatment courses of oseltamivir (Tamiflu) and9.9 million courses of zanamivir (Relenza). Bothdrugs are neuraminidase inhibitors; oseltamiviris the recommended first-line treatment for H5N1 infection. .The progress report say HHS has reached out tostate and local governments, medicalprofessionals, religious leaders and ethicists,business, organized labor, and individuals

forhelp in pandemic planning. Recent effortsincluded two public meetings in November and aWeb dialogue last December that drew more than400 people from 37 states into a discussion ofthe proposed vaccine allocation plan.During a recent pandemic simulation exercise, CDCofficials said it would take at least 4 or 5months to start producing a vaccine well-matchedto an emerging pandemic virus. Last October HHSreleased a draft vaccine allocation plan thatassigned priority to deployed military and othercritical national security personnel, emergencymedical services and public safety workers, keygovernment officials, medical providers andpublic health workers, pregnant women, infants, and toddlers.In the recent meetings and forums, the progressreport says, "experts and the public identifiedthe most important vaccination goals asprotecting those who will be the first to

respondto the pandemic and care for the sick, those whokeep vital community services working, those whohave increased exposure due to their jobs, and pregnant women and children."Some senior citizens involved in the discussionssaid they would willingly give up their vaccinedoses in favor of their grandchildren, despitethe likelihood that their own mortality riskwould be high, the HHS report says."Based on these dialogues and the thoughtfulinput of so many segments of society, a workinggroup of government officials is in the processof refining the allocation plan with the goal torelease the plan in the coming months," it states.Other recent collaboration efforts, the reportsays, included nearly 20 meetings around thecountry last fall to consider "the sharedresponsibility concept of stockpiling medicalcountermeasures (vaccines, antivirals, rapiddiagnostic tests, and

masks/respirators), as wellas private-sector stockpiling of antivirals.." HHSplans to draft a guidance document on thosetopics, but the report lists no timeline.In other areas, the report says HHS:* Has awarded 27 contracts worth $3.5 billionsince 2005 to develop plans and begin projects inits medical countermeasures program* Has invested more than $130 million inresearch on vaccine adjuvants (substances thatboost the immune response to a vaccine)* Plans to study the knowledge, attitudes,beliefs, and communication message needs ofvulnerable groups such as the homeless andnon-English-speakers, with the aim of developingmessages about community mitigation measures for combating a pandemic.See also:HHS report "Pandemic Update V"<http://www.pandemicflu.gov/plan/panflureport5.html>http://www.pandemicflu.gov/p\lan/panflureport5.htmlMar 14 CIDRAP News story"<http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/mar1408states.h\tml>HHSissues pandemic planning guide for states"<http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct2407allocatio\n.html>Oct24, 2007, CIDRAP News story " Pandemic vaccineproposal favors health workers, children"Jul 19, 2007, CIDRAP News story"<http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/jul1907update.h\tml>HHSupdates pandemic stockpile totals and planning efforts"

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