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Frustration with swine flu vaccine

Posted: Monday, October 26, 2009

The following editorial first appeared in the Washington Post:

As vaccination efforts go, the one under way for the H1N1 virus (aka swine flu) has not gone smoothly. Lower-than-expected vaccine yields have reduced the number of doses available, and this has led to the cancellation or scaling back of vaccination clinics across the country, including in Maryland and Virginia. After eight years of talk about preparing for either biological attacks or life-threatening pandemic influenza, the performance is worse than disappointing.

Some of the pandemic planning has worked. When swine flu burst onto the scene in April, the government had contracts in place with five vaccine manufacturers that allowed it to immediately start the lengthy process of preparing a vaccine. The government runs 35 chicken farms for the sole purpose of producing eggs to be used in vaccine production.

But in trying to get vaccine to people who want and need it, the process has run off the rails. Because swine flu vaccine yields did not meet manufacturers' initial estimates, filling the orders of states and localities has been pushed back by at least two weeks.

There's been considerable confusion about availability. Given the spread of the illness now, the promise that all who want the vaccine will eventually be able to get it is cold comfort.

That's especially so for people deemed at risk - pregnant women, those who live with or care for children younger than 6 months, people 6 months to 24 years old and people 25 to 64 with underlying health problems such as diabetes or asthma.

Meanwhile, there have been problems in distributing the seasonal flu vaccine as well. Hospitals, clinics and other venues have been scrambling to make do with what they have, if they have any doses at all.

Congress passed laws to prepare the nation for pandemics and possible biological attacks in the aftermath of the al-Qaida and anthrax attacks of 2001. Lack of progress became apparent during the planning for avian flu in 2005. There was plenty of talk then about the need to move away from egg-based vaccine production in favor of more flexible cell-based technology.

Doing so would cut production time almost in half from between 20 and 23 weeks to between 12 and 14 weeks and would result in larger amounts of vaccine per lot. But the first facility to employ cell-based technology, which comes online next month, isn't expected to be able to manufacture U.S.-licensed flu vaccine until 2011. This points up two other issues. That facility is part of a five-year, $5.6 billion pandemic preparedness plan at the Department of Health and Human Services. This is only the third year. And of the five vaccine manufacturers with federal contracts we mentioned earlier, only one is on U.S. soil.

Swine flu is spreading rapidly and overwhelming clinics and hospitals, but it is still considered relatively mild. The best way to protect yourself and others remains washing your hands or using hand sanitizer, covering your cough or sneeze, and staying home from work or school if you or your children feel sick.

But had the H1N1 virus mutated into something more virulent over the summer, the nation's inadequate infrastructure and inability to respond efficiently would have been even more consequential.

In some ways, the federal government caught a lucky break with H1N1. But when it comes to the public's health, depending on luck isn't good enough.



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