Critical infrastructure employees to receive vaccine in influenza pandemic

Published 13 December 2007

HHS, CDC, and other government agencies conduct three-day public discussion on how to prioritize allocation of vaccine during an influenza pandemic; majority of discussants emphasize need to distribute vaccines first to employees in critical infrastructure

As U.S. officials wrap up efforts to gauge the public’s response to a draft plan for allocating vaccine supplies during an influenza pandemic, suggestions to fine-tune the plan are emerging, such as giving higher priority to critical infrastructure workers, the families of key healthcare workers, and community pharmacists. A three-day Web dialogue, held 4-6 December, drew about 420 people who either participated in or observed guided discussions on various aspects of the pandemic vaccine prioritization draft, according to summaries of the dialogue posted on the event Web site. The event was sponsored by the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), along with the Association of State and Territorial Health Officials (ASTHO), and National Association of County and City Health Officials (NACCHO). The groups, with assistance from the Keystone Center, a nonprofit science public policy group based in Keystone, Colorado, are holding a stakeholder meeting in Washington, D.C., today. They also sponsored a series of public engagement meetings in January in Las Cruces, New Mexico, and Nassau County, New York, and in November in Milwaukee and Henderson County, North Carolina. HHS is taking comments on the draft pandemic vaccine allocation plan through 31 December, according to a Federal Register notice.

A federal interagency working group presented its vaccine prioritization draft to HHS’s National Vaccine Advisory Committee on 23 October. The tiered approach lists key health and safety personnel and children as top priorities. During the Web dialogue, participants offered several ideas for revising the draft guidance, according to daily summaries on the dialogue Web site. Some suggested that adding an age criterion to the occupation groups might help the plan fulfill its goals of reducing deaths and maintaining critical infrastructure. “It was noted that the draft guidance is not age-based, but leans more toward protecting society (critical infrastructure) and the population groups at the top [of the priority lists],” the summary notes. One of the main themes, according to the daily summaries, was protecting critical infrastructure, especially the electric power grid. Employees who maintain electrical systems should be moved to the top tier, many of the participants said. “Some suggested that the only true critical infrastructure is electric power,” the dialogue summary said. Employees that maintain power systems “should receive the highest priority for prophylactic antiviral medications, have special support for their families, and be first in line for vaccine,” the summary noted.

The vaccination priority of family members was also raised several other times during the Web dialogue. Though many participants seemed to support family coverage for first responders and other key healthcare workers, there was less of a consensus on priority status for the families of military members and homeland security employees. Some surveys have indicated that many healthcare workers will not show up for work during a pandemic if their families don’t receive antiviral medication or vaccines and if they don’t have adequate personal protective equipment. Some participants said the final vaccine priority plan should factor in important supply chain issues and protect workers who produce and deliver necessities such as raw materials, medicine, food, and fuel.

The discussion moderators asked participants what the government should do to make the vaccine priority plan more acceptable to the public. Suggestions included keeping citizens informed when supplies of vaccines and antiviral medications change. “Citizens will be enraged if their expectation is not adjusted before a pandemic starts. Set the policy for the current reality and be up-front about the implications,” the summary said. Though the discussion summaries do not suggest that participants supported moving many groups down on the priority list, a poll at the end of the dialogue asked participants to make some difficult choices. Support for protecting critical infrastructure workers grew as the Web dialogue progressed, said Nicholas Kelley, a masters’ degree candidate in environmental public health at the University of Minnesota, took part in the dialogue during all three days. “You could see a real shift by the third day. People were adamant about critical infrastructure,” he said. “In a public forum, there are always possibilities for heated emotional exchanges, but the Web format included well-articulated and thought-out comments,” Kelley said of the Web dialogue. In a previous report, the federal interagency working group said that after receiving public comments it would revise the vaccine prioritization plan, which will be considered a final interim report.