Antivirals and Vaccines for Pandemic FAQ
Answers to questions posed at the May, 2006 pandemic plan preview meetings.
In event of vaccine or antiviral shortages, how will we prioritize essential personnel and the general public?
Initially, tiers were developed in the Pandemic Strategic Plan that was released last November. The states want more guidance to identify the critical frontline workers and to develop implementation plans for use of the vaccines and antivirals. There is ongoing work being done on these issues at the federal level. A multi-agency federal workgroup, along with numerous stakeholders, is looking at the identification of the essential personnel as well as the stratification of the personnel within the groups. Initial results from this workgroup are expected in the fall of '06. It is not known how much flexibility the states will have in interpreting the revised priority groupings.
We understand the CDC will distribute vaccine directly to the state. Will this be distributed to all county offices and all Minnesotans? Will federal employees receive vaccinations?
The plan for distribution of vaccine at the state and the federal level is in development with a number of options being considered. Distribution may be a mixture of systems already developed in the state such as the one used for the Vaccine For Children Program, which is a private/public collaboration, or the Strategic National Stockpile Program (SNS), which is a federal/state/local collaboration. MDH is waiting to hear more on these options from the federal level.
The vaccine may be administered at the LPH level via county or regional mass dispensing sites initially. Other options may become available as the pandemic continues. The goal is that all Minnesotan will receive a vaccine for the pandemic strain.
The state is working with the federal employees within Minnesota to ensure that they are protected.
What is the state doing about antiviral deliveries to clinics, pharmacies, or other dispensing sites?
The state is waiting for more guidance from CDC. Some of the antivirals will be delivered within the Strategic National Stockpile program, and others may come from regional or local caches. Minnesota is developing antiviral dispensing plans that are flexible because of our urban and rural characteristics. Where the vaccines and antivirals will be delivered depends on the final decision on where the administration and dispensing will take place. They may take place at public health clinics (mass dispensing sites), occupational health clinics, doctor’s offices, pharmacies, or other sites.
How will people be called to mass dispensing sites? Regions would like more guidance on how that will roll out (by zip code, social security number, brown hair, etc.)?
For a pandemic event, there will be a controlled summoning to the dispensing sites for critical workers, priority groups, and then the general public. This will be based on the prioritization system that is adopted for that purpose. That system has not been developed as yet.
At what stage of a pandemic would prophylaxis of first responders (and other essential personnel) begin?
It depends on what type of prophylaxis is being discussed.
Pre-pandemic vaccine (H5N1 strain) is the vaccine that is being produced and stockpiled for the strain of avian influenza that is currently circulating and infecting humans in other parts of the world. It is unknown how effective this vaccine will be against the human-to-human pandemic strain, but there is reason to believe it may provide some level of protection. It would be administered to critical workers after human-to-human transmission has been established and CDC releases the vaccine to the states. It will be a small amount and will be given based on federal recommendations for critical worker prioritization, which have not yet been established.
Antivirals will be given for treatment and prophylaxis of priority groups when there is disease in the community. How much will be allotted for treatment and how much for prophylaxis is not yet established.
Pandemic vaccine will be administered to critical workers and priority groups first and then the general public as soon as there is vaccine production. Vaccine will first become available 4-6 months after the pandemic strain is selected, so the initial doses may become available during or after the first wave of illness.
How will the public get prioritized after the critical workers get their vaccine. There should be consistency so that each region/county doesn’t do their own prioritization.
This is another issue that is being reviewed and developed at the federal level. Just as Minnesota wants to be consistent within our state, we also want to be consistent with the national trends. This topic also focuses on numerous ethical issues, which are being discussed within workgroups throughout the country and in Minnesota. A transparent, ethical framework is necessary to assist in rationalizing to the public the difficult decisions that must be made in dealing with scarce resources, such as prophylaxis. Work is ongoing on this subject.