In addition to Daily Kos, I also blog at the Arena, where the question was asked
Does the administration appear to have its act together on the flu? If not, how hazardous is it to Obama's political health?
My answer, in full, can be found here after a longish summary, but the salient point is this:
Everyone aware of the big picture, which mitigates but does not eliminate the frustration, and CDC and other health officials have been both visible and active from the beginning. The big mistake, acknowledged, is promising more than can be delivered. The deliverables are there, however, even though late, and that’s a different problem than never having the goods in the first place.
We are seeing this play out to the backdrop of a big spike in influenza like illness (ILI) cases (we know it's H1N1 because there's no other flu circulating right now.)
There are some things in the news worth highlighting, though.
- WHO recommends only one vaccine dose (not two), and also recommends any form (live attenuated nasal spray or killed vaccine) for any patient (link)
Given concerns about vaccinating pregnant women, the WHO panel looked at animal studies of all forms of the vaccine and found no evidence of direct or indirect harm to fertility, pregnancy, embryonic or fetal development, birthing, or postnatal development. Given the high risk of flu complications in pregnant women, the group said any licensed vaccine can be used in pregnant women, unless specific contraindications have been outlined by national regulatory bodies.
While not binding, the recommendations are designed to match safety with need, and free up as much vaccine for the world's population as possible. Most flu deaths take place in the third world, and many third world countries are ill equipped to handle either a pandemic or the price of vaccine, so even as we harbor doubts in this country about vaccine safety, this is welcome news for the rest of the world.
At a separate press briefing today (see question from Rob Stein), reporters asked Thomas Frieden, MD, director of the US Centers for Disease Control and Prevention (CDC), about the difference between the SAGE [WHO expert panel] recommendation and the CDC's guidance. He said preliminary vaccine data on children have not shown the desired immune response in children that would warrant a single-dose recommendation. Though the CDC is anticipating new data soon from the National Institutes of Health, "for the time being, we're sticking with what the ACIP [Advisory Committee on Immunization Practices] has recommended," Frieden said.
Items 2 and 3 (below) need to be taken together. Adverse effects make vaccine demand go down; deaths — especially pediatric deaths — make demand go up. There'll be many more deaths than there will be adverse events, though, a simple fact that sometimes gets lost in the discussion about vaccine safety. In the meantime, there's a vaccine safety page here.
- Background rates of adverse events need to be understood and studied, rather than assuming vaccinations are the cause (link).
Hundreds of people on any given day will die, develop the paralyzing Guillain-Barre syndrome or have spontaneous abortions, and that doesn't necessarily mean that their swine flu vaccination shot was to blame, a new study says.
As millions of people worldwide begin getting the new swine flu shot, public health officials are bracing for rumors about dangerous side effects linked to the vaccine.
To provide context, experts combed hospital databases and population samples in Britain, Canada, Finland, the United States and elsewhere to find daily baseline rates of commonly reported events like Guillain-Barre syndrome, sudden deaths, seizures and abortions. The research was published online Saturday in the British medical journal Lancet.
- In a CDC press conference, the high rate of pediatric deaths from H1N1 was highlighted (link).
Children are particularly high priority for prevention and for treatment. This is a younger people's flu. In a usual flu season, 90% of the deaths are among people over the age of 65. In H1N1, 90% of the deaths are in people under the age of 65. Up until now, there have been 114 laboratory confirmed deaths among children. More than two-thirds of those have been children with underlying conditions.
This, of course, is frustrating for parents trying to protect their kids but facing vaccine shortages that will drag on into November and December. That was addressed by Tom Frieden, the CDC Director as well:
H1N1 vaccine supply is increasing steadily. There’s not enough for all providers or people who would want it. And this understands to be frustrating. But the gap between supply and demand is closing. Last week, we had 16.1 million doses available. As of Friday morning, 5:00 a.m., for shipment. As of today, we have 26.6 million doses available for shipment. That’s an increase of 10.5 million doses in that seven-day period. With that vaccination, with that increase in vaccine availability, we're seeing more schools doing vaccine clinics. We’re seeing more health care workers getting vaccinated. More people at high-risk are being vaccinated. More providers are getting the vaccine. But it's not nearly as available as we'd like.
We'll need over 50 million doses to cover all high risk groups ( and at 10 million doses a week, that'll be another 3 weeks in coming.) Now not everyone in those groups is asking for vaccine, but enough are so that we are seeing shortages.
- Tamiflu in Short Supply as Flu Season Hits (link)
The demand for Tamiflu is so great this year that the manufacturer is only producing the stronger adult capsule version. That's in effort to get more of the medication on the market, since the capsules provide 25 times the dosage of the children's liquid version and can be produced in the same amount of time.
Pediatric tamiflu is getting harder to find, though individual pharmacies can make up for that by mixing adult capsules with syrup (or "compounding") from the readily available adult stockpiles. There are several reasons for the spot shortages. The seasonal need is not great, so pharmacies don't stock up. Demand right now, however, is high. The commercial suspension expires sooner, and takes up more space. Also, not all pharmacies are compounding (from my spot check this weekend.) Physicians may have to make 3-4 phone calls to find what they need. Usually, something somewhere can be found. A CDC Q&A about pediatric tamiflu is here. Most states have a 211 info line, and the state Department of health numbers can be found here, if you have problems finding medicine.
So, was all of the above unexpected? Not really. This is a pandemic, and in pandemics there are always illness, deaths and shortages. it's why "mild pandemic" is an oxymoron. We never have enough "staff, space and stuff", our shorthand for shortages. The enormous amount of disease means that we can cope, but only with strains on all parts the system, and some of those parts are not entirely up to the task. That's especially true locally, where budget constraints and uneven planning means that some states are well organized, others are playing catch-up. We've been reporting on that for years, and it's no surprise for regular readers. This is what I wrote a year and a half ago, before the pandemic hit:
There's only one problem... no matter how hard you try, you'll still run short. And for that reason, even creative solutions will need to be coupled with unpleasantry in the form of rationing. Whether it's rationing of space or of resources, triage of pateints will be an inevitable consequence of too many ill and not enough resources.
We're very lucky it's not worse than it is. And in the meantime, vaccine will help mitigate illness for some. The rest of us will have to make do as best we can until more is available. And next time you are asked to invest in public health infrastructure, especially locally, please do so. It's when you don't have it that you appreciate it the most.
