Biosecurity Briefing

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Federal Government Releases Final Guidance on Allocating Pandemic Influenza Vaccine

By Kunal Rambhia, July 28, 2008

On July 23, 2008, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Homeland Security (DHS) released the final version of Guidance on Allocating and Targeting Pandemic Influenza Vaccine. This final document includes input from stakeholders and the public obtained via written comments and public engagement and stakeholder meetings.¹ As previously reported by the Biosecurity Briefing on October 26, 2007, the vaccine allocation strategy focuses on the following four objectives:

1. Protecting those who are essential to the pandemic response and provide care for persons who are ill;
2. Protecting those who maintain essential community services;
3. Protecting children; and
4. Protecting workers who are at greater risk of infection due to their job.¹

After reviewing the draft guidance, the public and other stakeholders prioritized the four vaccination program objectives in the same way.¹

The guidance recognizes that “plans are flexible as the guidance may be modified based on the status of vaccine technology, the characteristics of pandemic illness, and risk groups for severe disease.” However, this document is intended to provide advice which will support consistent planning by states and communities.¹

The document divides people into target groups based on “occupation, type of service, age group, or risk level.”¹ These target groups are then organized into one of the following categories:

1. People who maintain homeland and national security;
2. People who provide healthcare and community support services;
3. People who maintain critical infrastructure; and
4. The general population.¹

The target groups would then be vaccinated in tiers, with the assignment of tiers being determined “depending on pandemic severity.”¹ The following table is a breakdown of target groups and their vaccination tier in a pandemic as well as the number of vaccines approximated for each group.

Table 1.Vaccination target groups, estimated populations, and tiers for severe, moderate and less severe pandemics as defined by the Pandemic Severity Index (PSI). Persons in occupational groups not specifically targeted for vaccination in Moderate and Less Severe pandemics are targeted according to their age and health status in the general population. (Reproduced from the Guidance on Allocating and Targeting Pandemic Influenza Vaccine.)

The document includes further explanation of the tiers as well as instructions for state and local communities. Specifically, the guidance calls for states and locals to develop “strategies for how persons in occupationally defined target groups should be identified and how their priority can be verified at the time of vaccination.”¹ Also, the guidance calls for planning for allocating and distributing vaccine, procedures for vaccination, and programs to follow-up on vaccinations and monitor for vaccine-related adverse events.¹ Finally, the guidance calls for the development of strategies and materials to help communicate the objectives of vaccine allocation to employers and the public.¹

References

1. U.S. Department of Health and Human Services, and U.S. Department of Homeland Security. Guidance on allocating and targeting pandemic influenza vaccine. July 23, 2008. http://www.pandemicflu.gov/vaccine/allocationguidance.pdf. Accessed July 25, 2008.