October 2007 NVAC Meeting Minutes
then 80 to 120 days from the first case to the peak of the first wave. However, he cautioned that we do not know where a pandemic will start. He also explained that once we have vaccine, it is unclear what that supply will be as that depends on the U.S. production capacity when the pandemic occurs as well as the antigen concentration per dose.
The next part of the presentation focused on the first national effort at pandemic vaccine prioritization, which occurred in 2005 as a joint activity of ACIP and NVAC. The process included the consideration of vaccine supply and efficacy, impacts of past pandemics by age and risk group, potential impacts on critical infrastructures, and ethical concerns. ACIP and NVAC’s recommendations were included in the 2005 HHS Pandemic Plan.
The priority groups for pandemic flu vaccination, identified by ACIP and NVAC, were divided into tiers and subtiers. The first tier for vaccination included healthcare workers, high-risk groups, and the elderly. However, several factors suggested a value in reconsidering the prioritization guidance. Planning assumptions evolved from a more moderate pandemic, which ACIP and NVAC used to establish the initial guidance, to a more severe pandemic. NVPO also heard from the public in four public engagement meetings. The public indicated that it was more important to protect essential services than high-risk individuals. Also, an analysis of critical infrastructures was conducted by the National Infrastructure Advisory Council (NIAC), a DHS Advisory Committee, which identified vaccination priority groups.
Because of this, an Interagency Working Group was established to reconsider pandemic vaccine prioritization guidance. The Working Group process included the presentation and discussion of prior ACIP and NVAC recommendations; scientific, public health, and ethical issues; analysis and recommendations on critical infrastructure (CI) by the NIAC; as well as national and homeland security issues. The Working Group held two public engagement meetings and a stakeholders meeting and conducted decision analysis. The Working Group also considered various ethical issues and included the participation of an NIH ethicist and ethicists from the Minnesota Center for Healthcare Ethics in examining process and content issues.
The NIAC analysis of critical infrastructure for a U.S. pandemic considered the following issues: The essential functions of critical infrastructure and key resource sectors, their interdependencies, and the workforces needed to maintain critical functions. The process included a survey of critical infrastructure and key resource operators, a review of existing data and plans, and interviews with subject matter experts. Overall, of the 85 million workers in CI sectors, 12.4 million were included in the top tier as most essential to preserving the critical functions in these sectors. The healthcare sector represents the majority of CI workers, with emergency responders coming in second.
The objective of the public engagement and stakeholder meetings was to consider the goals of pandemic vaccination and assign values to each of them. A total of 328 individuals participated in these meetings in Las Cruces, NM, Nassau County, NY, or Washington, DC. The top four objectives for vaccination were identical at each meeting. These objectives included protecting people who are working to fight the pandemic and provide care, protecting those who provide essential community services, protecting those who are most vulnerable, and protecting children.
The last part of the development process was decision analysis. In this decision analysis, NVPO defined 57 different population groups by their job, age, and health status. The Working Group then rated the extent to which each group met occupationally related objectives. Then CDC and external influenza experts rated the extent to which each group met “science-based” objectives. Different weights were then applied based on Interagency Working Group public and stakeholder values, and they came up with an overall score for each of the different population groups. The results showed that the groups that ranked the highest included public health responders, healthcare workers, emergency medical service providers,