CDC Acts To Counter Swine Flu's Unknown Magnitude

The federal government has taken a big step toward getting millions of Americans vaccinated against pandemic flu. The Centers for Disease Control and Prevention has decided who should be first in line for the vaccine this fall. But experts are worried that people may not come forward to get the new vaccine.

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The government has taken a step toward getting millions of Americans vaccinated against pandemic flu. The Centers for Disease Control and Prevention has decided who should be first in line for the vaccine this fall. But experts are worried that some people may not come forward to get it. NPR's Richard Knox reports.

RICHARD KNOX: The CDC views the vaccine advisory panel's meeting as a watershed event. It's only the second time in 23 years that the nation has mounted a crash campaign to vaccinate millions against a swine flu.

In 1976, an outbreak of a different swine flu virus turned out to be a false alarm. It never got beyond an Army base in New Jersey, but 40 million people got vaccinated against it before the campaign was canceled because of unforeseen side effects.

This time, there's no doubt the swine flu of 2009 is a real threat, but of unknown magnitude. Dr. Anthony Fiore, a CDC flu expert, ran through some interesting numbers about the out of season flu outbreak the nation experienced this spring and summer.

Dr. ANTHONY FIORE (Centers for Disease Control and Prevention): During May to July of 2009 we had essentially a winter season's worth of cumulative hospitalization in five to 17-year-olds, and nearly a winter season's worth in the 18 to 49-year-olds.

KNOX: People under 52, that's most of the population, have no resistance to the new flu, so it can spread easily and it can make some healthy young people very sick. The recommendations of CDC's 15-member advisory panel reflect this.

They said the first doses of vaccine, expected some time in October, should be reserved for five groups: pregnant women, people who live with or care for infants younger than six months, health care workers and emergency services personnel, those between six months and 24 years old, and people between 25 and 64 who have chronic conditions or weak immune systems. That adds up to something like half the U.S. population, around 150 million people.

The panel shied away from recommending that any of these people get priority over anyone else. But Dr. Anne Schuchat of the CDC says some rationing might be necessary. She calls it a just-in-case plan.

Dr. ANNE SCHUCHAT (CDC): A prioritization scenario might be necessary if the initial supplies are very limited or if in local communities there's just not quiet enough. And so they did come up with a who's first in line kind of scheme.

KNOX: This more limited group includes 41 million Americans, such as people who do direct patient care rather than all health care workers. But there's a dilemma. Rationing a vaccine can backfire. It's not only confusing and complicated to administer, it can discourage people from seeking a flu shot.

Dr. William Schaffner of Vanderbilt University warns health officials not to over specify who should get the vaccine.

Dr. WILLIAM SCHAFFNER (Vanderbilt University): Prioritization results in vaccine not being used. If the demand is not there you'll ask yourself, how long do I have to keep this vaccine waiting for people in the priority group to come in. Happens every time you prioritize. The only sin is vaccine left in the refrigerator.

KNOX: That's just what happened in 2004. A dire shortage of vaccine, due to the shutdown of one manufacturing plant, turned out to be an excess when public demand for flu shots fizzled. Officials have yet another challenge. Despite limited testing of the new vaccine, health officials have to persuade people it's safe. To do that they emphasize it's made the same way as tried and true seasonal vaccine.

They've already taken steps to diffuse the objections of some parents who are convinced that a preservative called thimerosal, often used in flu vaccines, is dangerous for young children. The CDC doesn't agree, but officials say those parents will be able to get a thimerosal-free vaccine.

Richard Knox, NPR News.

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