Pandemic Response: Experts fear that lessons from the 2009 H1N1 vaccine drive have been ignored

That was exactly 10 years ago, and the H1N1 influenza virus was widespread throughout the country.

“We made a huge investment in 2009,” said Moore, now Deputy Director of the Vaccine Education Organization. Vaccination Action UnionDescribed the spreadsheet whirlwind and brainstorming sessions, and eventually coordinated and operated 1,500 pharmacies, hospitals and clinics.

“After that, everyone returned to business as usual, knowing that the next pandemic was coming,” Moore said. “We knew we needed to rebuild everything again.”

Now as the United States stands up for a vaccination drive against the novel CoronavirusBacked by reports of promising results from two major clinical trials, Moore and other experts said the 2009 H1N1 pandemic, from continued investment in public health infrastructure to transparent and fact-based use. I’m dissatisfied with the fact that many of the lessons of the communication strategy have not been addressed. Some of those insights have been ignored and some have been blatantly ignored, but other conundrums remain unresolved and looming for future distribution of the coronavirus vaccine.

Federal authorities have called on state and local health departments to: Pay attention to the lesson Since 2009, future vaccination programs have been warned to be much more complex.

Instead of adjusting the flu vaccine to attack new strains as in 2009, pharmaceutical giant Pfizer and biotech company Moderna reported this month that the vaccine was more than 90% effective against the new disease. Inventing new technology to do this. .. H1N1 affected people under the age of 65 disproportionately, but the highest risk of coronavirus-induced disease covid-19 is due to the effects of the vaccine in the elderly and weakened immune systems. People in an existing state of decline. And next year, people will probably need the vaccine twice (every 3-4 weeks). Vaccines can be delivered in large quantities and should be stored at very low temperatures.

The lessons most often quoted from the H1N1 response are common to current pandemics and may already prevent future distribution of coronavirus vaccines. The danger of an overly ambitious government message.

Production problems delayed federal pandemic vaccination in the fall of 2009, as did the increase in deaths, especially among children. People were lined up for life-saving vaccinations, but by mid-October, only about a quarter of what authorities had promised for months was available.

The public health department canceled the vaccination clinic because it was not known when more supplies would arrive.People are Messed up And I lost confidence in the government’s strategy. By the time sufficient vaccines were available, the threat of H1N1 had diminished and many people were no longer interested in being vaccinated.

At a meeting of vaccine experts in 2010, then Secretary of Health and Welfare Kathleen Sebelius mentioned the over-promise as one of the “teaching moments” of the pandemic.

In a recent interview, Sebelius clearly categorized his message under President Barack Obama as “absolutely committed to following science and leading science,” despite his expectations. I acknowledged the danger of making it too high. The “garbled and contradictory” message that has made science counter politics under President Trump.

According to public health experts, the current administration refers to the coronavirus vaccine as if it were a quick end to the pandemic, rather than taking the lessons of 10 years ago and the more complex hurdles of the future seriously. I am. Government officials, such as Secretary of Health and Welfare Alex Azar, continue to be far more enthusiastic about the rapid effects of vaccines than infectious disease experts who have been closely associated with previous efforts.

“It’s a note about how much you want to get vaccinated,” said Thomas Frieden, who became director of the US Centers for Disease Control and Prevention in 2009.

“Many things can go wrong,” said Frieden, current president of Resolve to Save Lives, a global epidemic initiative. “A lot.”

The politicization of public health and the explosive growth of conspiracy theories will be countered in 2009 by immunologist and senior scholar Gigi Gronval of the Johns Hopkins Health and Security Center in both her professional life and personal interaction. Exacerbated the threat of false and disinformation that helped.

Gronvall remembers an inbox full of messages from acquaintances concerned about the safety of the H1N1 vaccine.

“I keep reading about it, and nothing really proves [to] One mother writes about the H1N1 vaccine, wondering whether to inject her child or use nasal drops. “But I also understand that it’s not safe not to get it.”

Gronvall replied with a newspaper article and CDC material on safety data.

“I would be very cautious because much of the internet about vaccines is complete garbage,” Gronnvall explained to his mother.

These old concerns about the H1N1 vaccine, which has the same manufacturing process as the seasonal flu vaccine, are now minimal compared to the combination of optimism and complete skepticism that has spilled around the coronavirus vaccine. The need for frank and factual communication became apparent in 2009, but now we are concerned that the adverse events that inevitably involve innovation are “manipulated to cause discord.”

An important point from the H1N1 vaccine was the role played by experienced healthcare professionals in communicating safety information to patients.

“The most important people are those who have syringes,” said Bruce Gellin, president of Global Vaccination at the Sabin Vaccine Institute and a former HHS employee. “They will be asked,’What do you think?'”

There are years of compelling safety data for influenza and measles vaccines. However, healthcare professionals do not yet have the information to formally answer questions about, for example, untested coronavirus vaccines in children.

These issues of building trust can be especially important when persuading people in the color community to get a new vaccine.

According to 2012, African Americans and Latin Americans were vaccinated at a lower rate than other groups in 2009. HHS rating Of a response aimed at strengthening readiness. Colored races are disproportionately affected by the coronavirus, just as historically they are at high risk for influenza, including H1N1.But the study A combination of access barriers, distrust of the health system, and perceived risks of side effects indicates that vaccination is unlikely.

To counter these trends, a minority is listed in the high-priority group of coronavirus vaccines. But even that designation is a complex factor when it comes to mass vaccination programs, experts say.

“Prioritying is important, but if you have a very large population, how do you do it in an efficient way?” Gerin said. “If you have a vial, [of the vaccine] Would get worse, do you wait for the right people to appear? “

In 2009, the vaccine was retained as a reserve for priority groups, including pregnant women and children, until it became clear that a limited supply was wasted. Some states have begun to relax the rules for targeting priority groups. In Maryland, we’ve found that pregnant and at high risk for H1N1 is consistent with others who aren’t high-priority recipients.

For two-dose vaccines, which can arrive in large quantities and need to be kept at cryogenic temperatures, achieving the prioritization goals is even more difficult. If one person receives a single dose and is not given a second injection, he or she wastes the dose that may have been used by another recipient. Also, due to the large number of vaccines under development, some people in the target group may decide to wait in the hope that there will be better options in the pipeline.

But perhaps the most striking lesson that has emerged since 2009 and promises to complicate future distributions is the lack of continued investment in public health.

“We need a plan. We needed a plan for quite some time,” said Jason Terk, a pediatrician and chairman of the Texas Public Health Union, recalling the lack of syringes and other consumables when administering the H1N1 vaccine. Mr. says.

Some of the 2009 logistical challenges were resolved by temporarily expanding Vaccines for Children, a 25-year-old federal program that provides free vaccinations to uninsured minors. It was. This initiative forms the backbone of the national H1N1 distribution program, with many states adapting their infrastructure to register new providers and health care workers who have problems ordering, receiving, or administering vaccines. We have created a hotline for you.

Launched in 1994, Vaccines for Children provides more than 50% of childhood vaccines, has been delivered to the state, and has been distributed to more than 40,000 private and public clinics nationwide. The program is valued for preventing hospitalization, saving lives, bridging vaccination gaps between white and colored children, and saving billions of medical bills.

“Like system [Vaccines for Children] Expanding to cover adults can have enormous benefits, “said Terk, while increasing agility in the next outbreak. Strengthen public health. The number of adult vaccines that protect against shingles, pneumonia, hepatitis, and other illnesses continues to grow, many of which are underutilized.

According to Moore, the biggest obstacle in 2009 hasn’t been resolved yet. Due to the lack of an extensive adult vaccination network involved in federal and state vaccination programs, there is no database ready to recruit the thousands of clinicians needed to administer the coronavirus vaccine. ..

However, she chooses to look ahead, hoping that the lessons learned from the coronavirus vaccine program will not be wasted.

“We hope to take advantage of this opportunity in ways we didn’t take advantage of 2009,” Moore said. “Temporary investment is not a way to do public health.”