November 3, 2009

Holes in U.S. Pandemic Response Include Vaccine Infrastucture

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Flu expert Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy, grades the U.S. response to the pandemic so far, and highlights what needs to be improved.

Dr. Michael Osterholm:

The preparation for this pandemic and the actual results is mixed I would say that the issue of how we educate the public, what they know about pandemic influenza surely has been a success. There's been a lot of activity in that area.

In terms of how businesses responded is mixed in the sense that some are much better prepared to deal with things like illness in the workplace, their supply chains and were they worried or were they able to respond to the issues, might not get the parts that they need from Asia. Others did nothing.

And then the last piece is really the vaccine issue. And that's one that with all preparation we did really is the area that we've got some of the biggest problems, because we're using the old 1950's technology and we can't improve on that.

To date we've really had what I would almost call a dry run situation, meaning that if this were 1918 like influenza again, we clearly would say that we have failed miserably in terms of the vaccine.

Because this is a relatively mild illness for most people and only severe for a very limited number, we have tolerated what I could consider to be a vaccine response that has at best been mixed. What we've learned from that is that even under the mixed kind of conditions is not acceptable and surely if this were a 1918 like situation, this would be a disaster.

The real problem we have with the influenza vaccine doesn't have to do with the government response, it has to do with the world's prioritization of living with the 1950's type technology that can never make vaccine fast enough, it can never make enough of it and it won't make a vaccine that in all cases will even work.

We've put a lot of emphasis on building a pipeline of vaccine that would go to the public. But what we really spent little time on was the faucets where that vaccine then gets out of the pipeline and actually into people's arms or up their nose. And we're now realizing that in fact many of those faucets are very rusty, it not completely rusted shut.

Again, this is not a surprise nor should it have been to anyone. We do not have an adult vaccine program in this country, meaning that we expect adults to get in routinely and get their immunizations. Unlike with children where we do have medical homes or we do have public health efforts to make sure children get vaccinated, we just never have done that for adults.

Now having said that in this situation we then said okay we're going to use those existing medical and public health resources in our communities to do the vaccinations. The problem is that in the last year in this country we've actually let more then ten thousand public health workers go because of severe budget constraints.

If you look at the issues around the health care delivery system in this country, we have had many, many private medical providers -- have to let go -- extra nurses, nurse's aides, etcetera, to again balance the books. These are the people that would have and could have been available to provide vaccine.

So, when you add this together with the fact that in our school based systems, school nurses have become almost a rarity, we really have a kind of perfect storm of events that means that no there isn't any way on an emergency basis suddenly to deliver lots of vaccine in a systematic way.