The President’s Council of Advisors on Science and Technology has released its report on H1N1 flu. We’ll have something to say soon about the report’s specific “scenarios,” its sometimes-mystifying use of language to communicate them, its several strong points, and the problems both epidemiological and ethical that are likely to arise when it is (if it is) put into practice.
A concern at first glance is whether this panel of estimable scientists is repeating an error of commission made by an earlier panel of also-estimable scientists — in 1976.
As DemFromCT points out at DailyKos today, “timing is everything” when it comes to response to this flu outbreak.
Along this line the PCAST report is clear: Having made the point that a return of swine flu this fall could infect a great many Americans, PCAST suggests that the federal government might decide to accelerate production of H1N1 vaccine.
The idea, generated by the PCAST’s 2009-H1N1 Flu Working Group, is that an early resurgence of flu would encounter an essentially unimmunized population — based on current expectations about availability of H1N1 vaccine. On p. 18, the report states that
“if an increase in severity is detected with the expected rate of transmission, broader administration of vaccine before complete clinical trial data are available may be appropriate…”
But here we note a disturbing replication of a disturbing history. The Advisory Committee on Immunization Practices, meeting on 10 March 1976, voted to recommend rapid preparation of swine flu vaccine and mass immunization of the American public in response to findings of H1N1 flu at Fort Dix, NJ.
At the March ’76 meeting, Russell Alexander of the U. of Washington School of Public Health asked how, if there were to be a mass immunization program, federal officials would know when to abandon it. What was the bail-out point to be? Would the committee specify a level of adverse vaccine events beyond which mass immunization would be suspended? Would it specify an incidence of H1N1 cases, or deaths, below which vaccine would be stockpiled but not administered?
The answer to Alexander was No. The directors of the CDC and other federal agencies did not want to be caught stockpiling usable vaccine if people were getting sick and dying of flu.
As it happened, Alexander’s suggestion might have saved a few lives, a lot of money, and a few officials’ jobs. By the time the 1976 immunizations began, it was known that there had been very limited spread of the swine flu strain beyond Fort Dix. Watchful waiting might have forestalled the 1976 fiasco.
If flu vaccine is again to be rushed into production and disseminated early, how should officials know when to put the program on hold — or to bail out entirely?
This entry was posted on Tuesday, August 25th, 2009 at 1:23 pm and is filed under Disease, epidemics, Health Professions, News, Outbreaks, Physicians, public health, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.