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October 2007 NVAC Meeting Minutes - page 23 / 40





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October 2007 NVAC Meeting Minutes

law enforcement, and children. These results were consistent with the public and stakeholder values as well as with the ethical principles.

The next part of the presentation focused on the actual draft guidance. Similar to the ACIP and NVAC guidance, vaccine will be administered in tiers, each of which includes several target groups. These target groups are defined in categories: Healthcare and community support services, critical infrastructure, homeland and national security, and the general population. Within each of these categories, target groups are then clustered in levels. Dr. Schwartz explained that NVPO defines vaccine prioritization strategies differently based on pandemic severity, be it severe, moderate, or less severe. However, the highest tier for vaccination, tier 1, is the same across all pandemic severities.

Dr. Schwartz concluded the presentation by reiterating that this is simply draft guidance. He also explained that there would be a 2-month comment period, additional public and stakeholder meetings, and a Web-based public engagement activity. During this time, NVPO will be working with sectors to validate population estimates and to consider options for implementation. Once the comment period has ended, changes will be made, and the final interim guidance will be issued. However, Dr. Schwartz emphasized the fact that pandemic planning has evolved and will continue to evolve as science and technology change. ACIP and NVAC have a special role in this process because of their expertise, their credibility in making vaccination recommendations, and their role in creating the 2005 guidance.


Dr. Birkhead began the discussion by stating that NVAC members should think about how they might organize their thinking in order to make a single NVAC statement.

Dr. Lovell asked what the best case scenario is in terms of time course between tiers 1 and 2. Dr. Schwartz replied that that depends on how much vaccine we have and when the pandemic occurs. Ideally, we would be able to vaccinate the entire population in a relatively short period of time and ideally sometime in the future not need to prioritize at all. However, until we reach that stage, strategy is important. Dr. Gellin commented that the largest piece of funding for pandemic preparedness is for vaccine development and that the goal is to vaccinate the entire population within 6 months; however, we are still a few years away from being at this final end point.

Dr. Birkhead wondered if there might be any overlap between the tiers or if one group would be completely exhausted before moving onto another group. Dr. Schwartz replied that there would likely be overlap in terms of implementation. The concept, however, is that all the groups within a tier would be vaccinated simultaneously. Dr. Schwartz continued by explaining that he would not expect to see any regional differences because the pandemic would spread so quickly. However, he did state that it does take time to develop immunity and that two doses of the vaccine may be required. A small supply of vaccine would be made available to States to distribute per their particular needs. Dr. Birkhead followed up by asking if this small supply of vaccine would be distributed through the State government. Dr. Schwartz confirmed that the vaccine would be distributed to States, which would then implement the program.

Dr. Gordon continued the discussion by asking how the two plans, the 2005 plan and the current draft plan, differ. He asked if a joint NVAC and ACIP meeting might be necessary and expressed the desire to see coordination, or at least a conference call, involving both Committees. Dr. Schwartz responded that one major difference between the two plans is that children are higher on the priority list with the current plan. He explained that some modeling studies have shown that we may decrease overall disease transmission by vaccinating children. Another difference between the two plans is that the current plan identifies critical infrastructure sectors higher on the priority list. The current plan also identifies

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