One-third of countries engaged in pandemic influenza
planning have not prioritized who should get vaccinations
and antiviral medications, according to researchers from
the Johns Hopkins
Bloomberg School of Public Health and the Ben-Gurion
University of the Negev, Israel.
The study authors performed the largest pandemic-plan
review to date, a targeted review of 45 national pandemic
influenza plans from developed and developing countries.
The study is published in the October issue of the journal
"Because of costs and the time delay of manufacturing
strain-specific vaccines, critical medical resources are
likely to be scarce in a pandemic and will require
rationing," said Lori Uscher-Pines, lead author of the
study and a doctoral candidate in the Bloomberg School's
Department of Health Policy and Management. "However,
we learned that individual countries have not consistently
prioritized population groups for vaccines and antivirals.
No countries prioritized population groups to receive
ventilators, face masks and other critical resources."
The study authors included 45 national pandemic
influenza plans in their study — 19 from developed
and 26 from developing nations. In total, the plans would
affect 3.8 billion individuals, or two-thirds of the world
population. The study found that 28 countries prioritized
individual population groups to receive vaccines in a
pandemic, and 22 prioritized groups to receive antiviral
The failure to prioritize antivirals is an unexpected
finding since they may be the first — and perhaps the
only — pharmaceutical intervention available to many
countries in a pandemic, the authors explain in the
Of the 28 nations that prioritized medical resources,
health care workers were most frequently ranked at the top
of vaccine and antiviral priority lists. After that,
countries differed greatly on who should receive top
priority: high-risk individuals, such as the elderly and
children; or essential service workers, such as
communications/telecommunications workers, firefighters,
key government decision makers and energy/power supply
The authors also learned that some countries made
children a top priority despite mixed epidemiological
support of this practice and a previous World Health
Organization recommendation against it.
None of these countries cited sociocultural values in
reference to this prioritization decision.
Senior co-author Ran D. Balicer said, "Prioritization
can play a significant role in international preparedness
against pandemic influenza. In the absence of explicit WHO
guidelines, nations should be encouraged and supported in
priority setting based on individualized pandemic-impact
estimates and should be guided in balancing evidence and
ethical considerations." Balicer is a researcher at the
Ben-Gurion University and co-editor of the Israeli Pandemic
The study was supported by a cooperative agreement
with the U.S. Centers for Disease Control and Prevention.
Co-authors from Johns Hopkins are Uscher-Pines, Saad B.
Omer, Daniel J. Barnett and Thomas A. Burke.