Tiered Vaccine Plan Puts Military, Infants First Government officials have devised a tiered system for distributing limited supplies of vaccine for pandemic flu. At the top of the "to vaccinate" list are critical military, health care responders, police, firemen, pregnant women, infants and toddlers.

Tiered Vaccine Plan Puts Military, Infants First

Government officials are thinking ahead about how to ration vaccines if and when a flu pandemic hits. After holding four public meetings and consulting with ethicists, officials have devised a new, tiered system for distributing limited supplies of vaccine.

Vaccine planner Benjamin Schwartz of the Department of Health and Human Services presented the plan Monday.

Schwartz explained that the highest tier will balance vaccination for critical military personnel, health-care and emergency medical responders, police, firemen, pregnant women, infants and toddlers.

The next-highest tier will include people who keep the nation's communications systems, power systems and water supply operating. It also will include children between the ages of 3 and 18.

Priority for the elderly depends on the severity of the epidemic: The more severe, the lower their priority. The authors of the plan made that decision because during public hearings, older people said they would rather that their grandchildren get vaccinated.

"The group that's in the last tier for vaccination is healthy adults between the ages of 19 and 64 years," Schwartz said, explaining that they are least likely to die or infect others.

The new draft plan earns high marks from bio-preparedness experts, but they foresee inevitable problems.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the plan is short-sighted because it only considers Americans and doesn't account for critical workers in other countries. He cites insulin as one example, noting that most insulin is made in other countries.

"Plants that make the insulin or the raw ingredients for making insulin are not able to produce that insulin," Osterholm said. "It doesn't matter if we have physicians and nurses to deliver that insulin in the U.S. — we won't have it."

HHS officials say that's something that can be considered as the planning goes along.

Thomas Inglesby, deputy director of the Center for Biosecurity at the University of Pittsburgh, said that right now, it's most important to get the public more engaged.

"To make the plan work, it's going to have to be discussed in churches, in town halls, in communities around the country," Inglesby said, adding that it's hard to get people to discuss such a stark problem before the actual crisis.

"If you tell a parent the day a pandemic is announced that their 5-year-old can't get vaccine till 100 million other people deemed critical personnel ... get vaccine first, watch out!" he said.

William Raub, science adviser to the secretary of Health and Human Services, said that they'll be looking for public comment in meetings and on the Internet.

"The main reason for the extensive consultation that's gone on already — and the even more intensive consultation that's going to go on now — is to try to prevent that from happening," Raub said. It's important "to have the public understand the issues that are involved, have the public see that we're quite serious about reaching out for its advice and equally serious about applying that advice."

HHS hopes to have a rationing plan by early next year, and Raub said they expect it will need revising as time goes on.