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The newspaper of The Johns Hopkins University October 23, 2006 | Vol. 36 No. 8
International Pandemic Flu Plans Lack Prioritization

Study: Countries vary in determining who should get vaccines, antivirals

By Kenna Lowe
School of Public Health

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 PLoS Medicine.

"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 medications.

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 study.

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 workers.

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 Preparedness Plan.

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.


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