Public health experts are gearing up for swine flu vaccinations this fall in what could be the largest mass-immunization campaign since the polio vaccine was introduced more than 50 years ago. Local public health agencies will bear much of the responsibility for vaccinating the public, and the state is receiving $30 million in federal grants to help prepare for an expected re-emergence of swine flu this fall.
For now, there are more questions than answers with regard to flu vaccinations, including how much of the vaccine will be made, when it will available, and who will get it first. In fact, the federal government has not officially announced plans to make a vaccine widely available, although it is expected to do so by the end of summer. “There’s still a lot of information we have to figure out, and we’re learning as we go,” said Dr. Mantu Davis, deputy health officer with the Alameda County Public Health Department. “It’s definitely a larger vaccination than anything we’ve seen, or anything in my lifetime.”
Voluntary vaccine likely
The last time the United States launched a major immunization campaign was after the polio vaccine was invented in the 1950s, when millions of children were immunized, many of them in their schools. The polio vaccine was mandatory, but a flu vaccine is likely to be voluntary.
California authorities designed a mass vaccination plan years ago, under the assumption of a deadly pandemic flu and a limited vaccine supply, said Dr. John Talarico with the state public health department’s Center for Infectious Disease. That plan is being revised, given that swine flu seems to be fairly mild so far and that a relatively large amount of vaccine may be available, even if it’s not enough to give to everyone at once.
The flu is mild now, but infectious disease experts worry that could change and it could return in the fall in a much more aggressive form, causing more serious illness. Even if it remains mild and very few people have natural immunity to it, swine flu could sicken millions of people and interrupt schools and businesses.
So far, the flu, a form of influenza Type A, subtype H1N1, has sickened more than a million people in the United States and killed 263, according to the Centers for Disease Control and Prevention. Worldwide, it’s killed more than 429 people, although the World Health Organization announced Thursday that it’s no longer counting specific cases because the virus is too widespread.
It is likely that county health departments, which will administer most of the vaccines, will go to schools first. In some counties, special clinics may open to provide vaccines for people at risk of serious swine flu infection, such as pregnant women or adults with pre-existing medical conditions. Large health care organizations such as Kaiser Permanente probably will be involved, and some people may get the vaccine from their doctor or at work, just as they would with the seasonal flu shot.
A vaccine is already well into development for the seasonal flu, and should be available as usual around September. But a swine flu vaccine is still being designed, and the World Health Organization reported last week that a licensed version may not be available until the end of the year – weeks after the start of the flu season. An unlicensed vaccine – one that is still being tested but is deemed safe enough for the general public – may be available sooner.
Whom to vaccinate
It’s unlikely that manufacturers will be able to produce enough vaccine right away to immunize everyone in the world – or in the United States. WHO has recommended that health care workers get the vaccine first, and public health experts have suggested that children and adults with pre-existing conditions be next in line.
Public health officials noted that it may be more important than ever for everyone to get a seasonal flu shot, because contracting both swine flu and seasonal influenza at the same time could be especially dangerous. What complicates matters for local public health agencies is that the people who are advised to get a seasonal flu vaccine are not necessarily the same people who should get a swine flu vaccine. For starters, the elderly are usually first in line for seasonal flu shots – but they seem to have some natural resistance to swine flu. So it might not make sense for them to be first to get vaccinated against the new influenza.
“There’s potential for a lot of confusion,” said Dr. Martin Fenstersheib, the health officer for Santa Clara County. “That’s why this early preparation is so important. It’s going to take some time to get the messages out to people. We’ll need people to understand that if you’re not at high risk and you have to wait for a second batch of vaccine, that’s OK.”