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Briefing on the Flu Season
Dr. Gerberding with Damian Braga, President,
Aventis Pasteur U.S.
Tuesday, October 12, 2004
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DR. GERBERDING: "This has been a very challenging week for all of us and we appreciate that those people who've been worried about flu, those people who are standing in line frustrated because they can't get flu vaccine, are the people who are angry about price gouging and the people who are perhaps confused about why they were asked to get a flu shot last year and this year there's not one available.
"All of these people have had a challenging week along with us who are trying to solve the problem. We don't know yet how serious the flu epidemic is going to be this year, so there's always some uncertainty in flu, but we do know that we need to be prepared and we are taking a number of steps that follow on some of the advance planning that we've been doing all along, after last year's aggressive flu season, and certainly since we learned about the potential for Chiron's delays in delivery in August.
"We also recognize that there are avian strains of flu still incubating in Western Asia, and that creates some additional uncertainty that we have to be planning for as well.
But right now, we can work together to solve this problem, and there are a lot of steps that have been taken and several more than we're going to be taking in the next few weeks that we think will help.
"The overall goal of this is to target the vaccine that we do have to the people who will get the most benefit from that vaccine, and to do it in a way that's fair and equitable to the greatest number of people across our country.
"We've made some decisions about how to allocate the vaccine, that's probably not going to make everybody happy, but we think that this is the first step toward doing everything we can to protect Americans from flu this year.
"So I really appreciate already the people who have stepped up to the plate and who are collaborating and cooperating with the updated ACIP/CDC guidelines about who should receive flu, and we have wonderful reports of grocery stores and pharmacies and clinicians and clinics and people all over our country who are really stepping aside to protect those doses for the people who need them most, and I really want to thank those people.
"I also really thank our state and local health officers who have been working very late nights trying to assess the supply and demand of flu in their region and help plan at the very local level for how to meet the demands that are there. They're the true heroes of public health and without their hard work, we wouldn't be as far along in the path as we are today.
"I also very much appreciate my colleague here, Mr. Braga, from Aventis Pasteur U.S., as well as the leadership of Chiron, the manufacturers of the vaccine that we have available in the United States. Their cooperation and collaboration in helping to reallocate vaccine has been absolutely extraordinary and we are extremely grateful to everything that they've done.
"What we've been working on for the past several days is to assess the 22.4 million doses of flu vaccine that have not yet been shipped from Aventis Pasteur to determine where were those doses of vaccine expected to go, where are the high priority populations of people where the need is the greatest, where are the gaps the greatest, and also working with Chiron to evaluate where their expected doses of vaccine were intended to go so that we can identify the priorities for Chiron and then reallocate some of the vaccine from Aventis to supply the people who were expecting to receive their vaccine from Chiron.
"I think you can understand that this just represents a very major degree of collaboration and cooperation across corporate boundaries.
"We have made some decisions about the first 14 million doses of vaccine. We have identified the doses that will be going to high-priority populations as they emerge from the production lines at Aventis. And as you know, this does not happen overnight. Vaccine comes out of the manufacturing facilities in Pennsylvania in an orderly manner, and so over this week we will be identifying, for the people who expect to receive an allocation, when they will receive it and how much they will receive by what date. But we are planning in this first phase of allocation to assure that high-risk children and the Vaccines for Children Program will receive vaccine because obviously they're a very high priority for us. We will also be providing to the pediatricians who have contracted with Aventis to get the supply as well as children in the Indian Health Service.
We also will be prioritizing the seniors over age--65 and older who have not yet been included in the vaccine catchment, so people in long-term facilities and the contracts with the Visiting Nurses Association and other opportunities to service those seniors are included in this first wave.
"We also know that there are states in the public sector who have not yet received vaccine, so Aventis has already shipped vaccine --about 50 percent of the state vaccine to most states, and we're going to in this first allocation make sure that states that haven't received vaccine get at least 50 percent of their contracted allotment that they had negotiated with Chiron.
"Over time, the states will be working at their updated projections of need because it's possible that their initial contracts were based on the assumption that there would be widely available vaccine and they have included people in their proposed vaccination who don't meet the qualifications for high priority. So there may be some downward adjustment at the state level in true need, and we want to allow for that flexibility, but not wait. So we're going to get that vaccine out to those states that are missing doses as quickly as we possibly can. That's obviously a very high priority.
"We also recognize that the VA Medical Center is highly populated with people at very high risk for influenza, and so we will be prioritizing release to meet the demands of the Veterans Administration and, of course, force protection so the full amount of dose needed by the Department of Defense will be supplied.
"Now, this leaves us with about eight million doses of vaccine that we have not yet allocated. Four and a half million doses will be in the CDC's stockpile, so we will utilize those doses as we identify high-priority gaps, and we'll have a great deal of flexibility to move that vaccine around in the way that best serves the people at highest risk.
"We'll also be working with the state and local health officials that I mentioned to identify ongoing critical needs. And we will be working with the many private providers, both those who contracted with Chiron directly and those who contracted with Chiron and Aventis distributors to make sure that we are identifying the greatest number of people and the greatest needs in those groups for this next wave of vaccine.
"So, in summary, what we're saying in this initial allocation is that we're going first to the people who need vaccine the most and where we can logically predict the greatest number of at-risk people. But we have allowed some flexibility so that we can readjust or change or re-evaluate the need for prioritization as we go forward. And we will continue to do this throughout the next several weeks, so we need to remember that this is a work in progress, and as new needs emerge or as people discover they have hopefully excess vaccine somewhere else, we have the best flexibility possible to, again, target vaccine to the people who need it the most.
"Let me also say that this is not all we're doing. Vaccine certainly is the best way to prevent influenza, but there are other steps going on right now at CDC and throughout the department to try to assure that we have the best possible outcome from this very difficult flu season.
"In particular, CDC is working aggressively to map out where flu is by county so that we will be able to detect, and perhaps even earlier than usual, areas where flu is emerging. We will also be making use of a new tool called BioSense, which is our system for taking in electronic information across our nation from over-the-counter drug prescriptions, from laboratory tests ordered, from the VA and Department of Defense medical facilities, and hopefully getting earlier warnings of places where flu activity is heating up so people can take extra steps to be prepared.
"We also are mapping the delivery of vaccine doses to each county across the United States, and this is another example where I have to thank the state and local health offices who are reaching out in their communities to identify doses, but also Aventis and Chiron who have provided us information about intended distribution to the level of the county so that we can, for the first time ever, accurately know where the vaccine actually is or soon will be.
"We're also mapping, again, with the help of health officials across our country, the people who need vaccine by county. So what we will end up with in a few days is a comprehensive picture, who needs it and where are they, where's the vaccine, and where's the disease so that we can use that information to help inform the allocation decisions in the next wave of vaccine release. We think this will help us get the best possible match between the doses we have and the need that people have for the product.
"CDC, last December, with the help of Congress, had a $40 million appropriation to augment the stockpile. So we have four and a half million doses of flu vaccine in the stockpile that I've already mentioned. We also have a stock flu--a stockpile of Tamiflu, which is one drug used to treat influenza or to prevent it, and we are in the process of purchasing a second drug, Rimantadine, to also have in the stockpile. We are hoping to purchase up to five million treatment courses of that drug.
"So when people can't get vaccine, if they're in a high-risk group and they need drug prophylaxis, we're trying to be sure we have a supply of that. We also will have these drugs available if we have illness that requires medical treatment and individual people in the medical sector can't provide the drug.
"And finally, I do want to again thank people across the United States who are really, I think, health heroes on the front lines of stepping aside so those who need vaccine the most can get it. But also there are some things that people can do beyond stepping aside for a vaccine that can help protect them and their families. And we just keep emphasizing how important it is to stay home if you're sick. If you have a flu-like illness, if you have a fever, it really helps if you don't go to work or don't go to areas of crowding where you can easily spread flu to somebody else. This is a very transmissible disease, but these kinds of common-sense measures will help. Likewise, kids should stay home from school, and everyone should use the common-sense methods of hand hygiene and covering your mouth and nose when you sneeze or cough to protect others from your respiratory viruses, whatever they might be.
"Also, as we move into flu season, people who are in the high-risk groups for complications, if they become ill or develop a fever or are suspicious that they have flu, they should seek early medical attention, because as I mentioned, there's treatment but that treatment is most useful if it's given within the first two days of symptoms. So we'll be helping to put out more information to give that kind of guidance as flu emerges across our country.
"So let me end that with just the final overview and that is that we recognize this is a tough challenge, we are going to do the best we can, we're sorry for the people who need flu vaccine and may not be able to get it this year, that's disappointing for all of us and we wish that wasn't the case, but we will take every step that we can take to get an equitable distribution of vaccine quickly as we can, and we appreciate everyone's help in pulling this together."
The complete transcript of this briefing is available at http://www.cdc.gov/od/oc/media/transcripts/t041012.htm