H1N1 COUNTERMEASURES STRATEGY AND ... - PHE Home

NBSB Pandemic Influenza Working Group
Detailed Report
Dr. Treanor: That sounds complicated, but it’s a good idea otherwise. Tailoring the
vaccine for the target population sounds good, but implementation is a problem. We
have trouble using vaccine in anything other than simple strategies.
Robert Field, J.D., Ph.D., M.P.H.: Public health ethics differ from clinical bioethics.
Mainly, public health is about populations—what’s good for large numbers—so it is the
principle of utilitarianism. Clinical bioethics focus on autonomy, such as the doctorpatient
relationship and the right to die. If we’re talking about protecting a population,
utilitarian concerns come into play. If the goal is to protect the safety of the population,
look at what gets the most vaccine out there. If the goal is to protect vulnerable
populations, then more specific issues come into play.
Keep in mind the importance of communication. Vaccine is such a hot topic, as we see
with the focus on exemptions, autism, etc. Consider economic, social, and other effects if
key people can’t function. Let your decision-making flow from your ultimate goals.
Brooke Courtney, J.D., M.P.H.: Liability is always an issue, but there are strong legal
tools and protections available, such as EUAs and the PREP act (as long as compensation
funds have money). Liability is important, but we shouldn’t let liability be too large a
concern with moving forward on these difficult decisions and paralyze our planning
efforts. If there is mass vaccination, one thing we tend to overlook is that it will largely
be coordinated at the State and local levels, which are already stretched to the max to
provide daily services and otherwise respond to the pandemic.
You may assume that if medical countermeasures are available, the public health system
will easily and quickly be able to get them where they need to go, but that will be
extraordinarily difficult, even with good planning; on top of mass vaccination, there are
the issues of receiving and storing Strategic National Stockpile assets, use and allocation
of antivirals, etc. Even though many health departments have significantly improved
their response capabilities since 2001 and are very well prepared, these are very
challenging issues, especially with the budget and staffing challenges that most health
departments are currently facing.
We need to consider how decisions about adjuvants might impact local public health
providers. If the timing is right, a better vaccine using less antigen means more people
could get vaccinated. Fewer people would potentially get sick, so the surge in health care
could be lower. Having more vaccine available potentially could mitigate difficult
vaccine allocation decisions at the local level. It’s hard to develop allocation plans on
paper but even more difficult to implement them at the local provider levels. So, a
shortage of vaccine means more challenging allocation issues at the local level.
On the other hand, using adjuvant in a hybrid approach would seriously complicate local
decision-making. There’s also the complexity of EUAs at the local level. If you go that
route, be sure to get information out as early as possible to public health professionals
and health care providers. If an EUA requires forms, such as instruction sheets to hand
out to the public, that’s a big deal—even things that might seem simple, like the logistics
of making copies, can be a big challenge for health departments. Whatever is decided,
make sure State and local public health providers get clear, consistent, early guidance
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