As the nation prepares for the return of the H1N1
influenza pandemic, public health officials are faced with difficult choices. While some doses of the
vaccine
for what is known as "swine
flu" will be ready by October, the entire supply will not be available for several more months.
Recently, two landmark meetings have been convened to discuss plans for the evaluation and use of vaccines against H1N1. On July 23rd, the Vaccine and Related Biological Products Advisory Committee (VRBPAC) of the FDA met to discuss ongoing vaccine trials and pathways for licensure or emergency use authorization of a variety of vaccines. On July 29th, the Advisory Committee on Immunization Practices (ACIP) of the
Centers for Disease Control met to determine who should receive vaccine first.
A single number has dominated these discussions: 600 million. That's the number of doses that would allow every American to be immunized twice (since this is a new
virus, it is possible that everyone will need two doses of vaccine to achieve protection). Debate and discussion have centered over the fastest and safest way to get to this number: whether, for example, some inactivated (killed) vaccines used in
the U.S.
could contain dose-sparing additives called adjuvants that might be used to stretch the supply of inactivated vaccine to get to 600 million more quickly, or how to best package a live attenuated vaccine, normally dispensed by nasal spray if, as appears likely, there will be more doses of this vaccine available than spray devices to administer them.
But is 600 million the right number? That the United States should aim to produce enough vaccine to protect all Americans is not at issue. What is not being addressed, however, is whether we ought to aim to do more. Nowhere in these discussions has the prospect of upping the ante been raised. Should we use available technologies to provide not only enough vaccine for the U.S. but also to allow for excess capacity to assist other countries who have no capacity to procure or produce the vaccine on their own?
Ruth Karron is the Director of the Center for Immunization Research and the Johns Hopkins Vaccine Initiative at the Johns Hopkins Bloomberg School of Public Health. Ruth Faden is the Director of the Johns Hopkins Berman Institute of Bioethics.
