Obama Administration Discusses Lessons Learned from Swine Flu

Public health officials did much to alleviate spread of swine flu in 2009, but more needs to be done.

Too many people still mistrust vaccines – health care providers included – and vaccine production technology needs a shot in the arm. That’s the takeaway from the swine flu experience of 2009, U.S. Health and Human Services Secretary Kathleen Sebelius said last week at the 44th National Immunization Conference in Atlanta. And while communication systems were strong during the early days of the swine flu outbreak, more needs to be done to reach out to some communities, especially minority communities, and above all physicians, Sebelius said.

“We shouldn’t have to convince health providers that vaccines are safe and that they work. But, despite the fact that we had more health providers than ever getting vaccinated last year, there was still a sizable number who did not. We need providers on the front lines. We need to make sure that the vulnerable people they work with aren’t at greater risk,” Sebelius said.

Sebelius’ address comes one year after the panic of last April, when public health officials were still puzzling out the new, aggressive strain of flu that had clearly invaded the New York City public school system. Later dubbed swine flu, the virus appeared to hop-scotch over typical influenza victims – the elderly and those with compromised immune systems – and instead was striking down and even killing young, otherwise healthy people and pregnant women with a vengeance.

The unknowns surrounding the swine flu – and the rapidity of its spread – created simultaneous panic over its origins and effects and suspicion over the vaccine that arrived on the scene. The World Health Organization declared an official pandemic in April of 2009, and has since had to defend itself against accusations that the declaration was motivated by a desire to enrich the pharmaceutical companies that were working on the vaccine. Too many people, including those whose medical conditions made them susceptible to swine flu complications, refused to take the vaccine out of fear it had been rushed and had not been properly vetted. Sebelius’ own agency, the HHS, had to admit that original estimates of the country’s ability to produce the vaccine had been overstated. This in particular is troubling to Sebelius, who used the confusion around vaccine production to illustrate the need for better vaccine production methods.

“This flu season has made us even more committed to ensuring that vaccine production—and all of our medical countermeasures—are state-of-the-art. Our experience with the ups and downs of the vaccine manufacturing process has made clear the need to enhance our country’s influenza vaccine manufacturing capability,” Sebelius said, adding the HHS was already working with vaccine companies to move past the “egg-based” technology, in which vaccines are basically grown in eggs, to more advanced and reliable method.

Sebelius is right. We need to learn the lessons provided in 2009 and then do it better next time. Some southern states are already showing swine flu activity, though it’s too soon to know if that will develop into a true outbreak. But if and when swine flu does return in greater numbers, we want there to be plenty of vaccine to give, and plenty of people willing to receive it.

Photo Credit: Justin Hourigan

Childhood vaccines protect even the unvaccinated

Giving children the flu vaccine can protect the wider community, study finds.

It’s obvious that giving a child the flu vaccine will protect him or her from the influenza. But a new study suggests the benefit of vaccinating children can extend well beyond the youngsters themselves. Results of a clinical trial conducted in a largely self-contained religious community during the 2008-09 flu season show that vaccinating children against the seasonal flu can significantly protect unvaccinated community members as well. The study was conducted to determine if children who received the vaccine could act as a barrier to limit the spread of the flu to the wider, unvaccinated community, a concept known as “herd immunity.”

According to the National Institutes of Health, researchers recruited volunteers from 46 Canadian Hutterite religious colonies that have limited contact with surrounding, non-Hutterite populations. (Hutterite communities have a lifestyle similar to the Amish and Mennonites). Of the close to 1,000 children participating in the study, roughly half were given the flu vaccine, while the other half were give the hepatitis A vaccine, which served as the control. The researchers found that the flu vaccine was 61 percent effective at indirectly preventing illness in unvaccinated people if they lived in a colony where approximately 80 percent of the children had received the flu vaccine.

The researchers further suggested that giving school-aged children the flu vaccine could be an effective way to stop the spread of the flu. In a statement provided by the National Institutes of Health, the researchers wrote “it may be advantageous to selectively immunize children in order to reduce community transmission of influenza.”

It’s not clear if the study gives license to assert the converse: Not giving your child the flu vaccine can actually harm others. But it’s certainly something to think about. I’m not ready to require that parents go out and get the flu vaccine for their kids as a requirement to attend public school. I do wonder if that might someday be the case for the swine flu, which cut a respectable swath of school closings across New York City last year. (In an open letter earlier this year to health care providers across the country, federal Commissioner of Food and Drugs Margaret A. Hamburg warned doctors of a “significant” chance that the swine flu will return later this flu season after showing recent signs of waning). We certainly do require other vaccines in order to attend school, despite some lingering fears among parents of their safety. In any case, I will take the opportunity here to suggest that taking care of yourself, which can include getting yourself vaccinated against the flu, is an act you owe not only yourself, but others in our society as well. I don’t want to legislate healthful habits, but I also think there’s something to be said for keeping healthy as a means of reducing health care costs and increasing productivity.

What do you think?

Photo Credit: UNICEF Sverige

Public health panel recommends flu vaccine for everyone

Global experiences with swine flu convince health panel to change recommendation and urge everyone to get flu vaccine.

An advisory panel to the nation’s chief disease tracker is urging all people above the age of 6 months to get the regular flu vaccine starting with the 2010-2011 flu season. Right now, the official flu shot recommendation is for children age 6 months to 18 years, the elderly, and anyone in between who is otherwise at risk for complications, such as people with asthma or HIV. The new recommendation would be for all persons 6 months and older to get the regular flu vaccine regardless of the otherwise healthiness and hardiness of their immune system. The recommendation needs official approval from the directors of the Centers for Disease Control and Prevention and the Department of Health and Human Services, which is expected to happen next month.

Members of the advisory committee who voted for the change were particularly concerned about the need to protect people 19 to 49 years of age, who were hard hit by the 2009 swine flu pandemic. Another reason panel members gave for universally recommending the flu vaccine is that many people who are considered “higher risk” are unaware of their vulnerability or that they are recommended to get the vaccine. The panel also said that the world’s experience with the 2009 swine flu pandemic taught them that some people who don’t currently fall into one of the specific recommendation categories for the vaccine may also be at higher risk of serious flu-related complications, including those people who are obese, post-partum women and people in certain racial or ethnic groups.

But lastly, and perhaps most importantly, the vaccine advisory panel said it is important to issue a “simple and clear” message about the importance of the flu vaccine in order to “remove impediments” and encourage more people to protect themselves. This is a good thing, especially after a year of watching, awe-struck, as young and healthy people not historically considered at risk for flu complications were struck down and hospitalized within hours of contracting swine flu. Seasonal and swine flu are different creatures, but the experience appears to have taught public health officials not to assume the relative immunity of healthy people against the flu.

We need less confusion surrounding the need for flu shots; we also need more flu shots. Any confusion eased by the new recommendations will just be compounded if public health officials fail to make enough vaccine to cover the people they recommended for the shot. Last year it took longer that expected to create the swine flu vaccine, which led to long angry lines of people and even panic. Many people were turned away, some tearfully, by public health officials who were forced to ration to the shots for the most vulnerable populations. Those people were assured that more vaccine on the way, and indeed it eventually arrived.

In releasing the news of its new recommendation, the advisory panel acknowledged that more doses will be required to cover all adults. However, the panel said more licensed types and brands of seasonal flu vaccines will be available in the 2010-11 flu season than has ever been available before.

Let’s hope so. Will you get the shot?

Photo Credit: alvi2047