Handling Vaccine Surplus

What to Do with Remaining Vaccine

Today the World Health Organization (WHO) is beginning a review into their response to H1N1 that is to last three days and will involve 29 external experts who will ensure the process remains “independent, credible, and transparent.” Much of the discussion will certainly center around the H1N1 vaccine and its implementation.

There has been continued backlash against the actions taken by WHO to combat H1N1—particularly in terms of amount of vaccine manufactured and purchased. Some accused the organization of falling under the influence of major pharmaceutical giants and ordering an excess of vaccine. Poland refused to buy the vaccine for its citizens, and the United Kingdom cut back its orders after the impact of the pandemic began to wane.

Demand for vaccine has fallen in the United States, where providers are being left with the task of disposing of extra doses that were ordered for local health departments and other vaccine providers.

The Centers for Disease Control and Prevention (CDC) had anticipated this type of problem. In an April 1 press briefing, Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, explained that the surplus was not unexpected. “It’s unlikely that all the doses that are out there in doctors'' offices and pharmacies and health departments will all be used up,” she said. “But we made a conscious decision to have more than enough vaccine instead of less than enough vaccine."

The CDC is now putting together a plan to assist state and local health departments in recovering and disposing of unused vaccine. Full details have not yet been released by officials.

How Bad Was H1N1?

With the decrease in H1N1 activity in the United States, except for pockets of activity in the Southeast, many doses of vaccine remain on the shelves. The CDC is encouraging providers to keep hold of their unexpired supplies, in anticipation of a possible new wave of the virus. Some of the doses of intranasal vaccine have begun to expire, but most of the injectable doses are not set to expire until 2011.

The fear of H1N1 and the rush to vaccinate gradually abated following a peak in demand in November. Public perception of the pandemic shifted. It began to look like a more mild outbreak that did not generally cause severe illness.

By comparing the number of deaths caused by H1N1 (17,000) to the number of deaths typically caused by seasonal influenza each year (36,000), H1N1 can be seen as a mild pandemic. Meanwhile, seasonal flu has virtually disappeared from the globe.

However, a recent study by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota looked at the impact of H1N1 based on estimates of years of life lost in the United States. The numbers were quite astounding with the estimate range between 334,000 and 1,973,000. More details of the study are outlined here:

• More than 85 percent of the H1N1 (2009) deaths were in people younger than 60, with an overall mean age of 37.4, as compared with an estimated mean age of 76 in those who die of seasonal flu.
• The H1N1 (2009) pandemic, so far, has taken a toll of between 334,000 and 1,973,000 years of life lost (YLL) in the United States.
• The 1968 pandemic, with 86,000 deaths and victims averaging 62.2 years old, caused 1,693,000 YLL.
• The 1957 pandemic, with 150,600 deaths and a mean age of 64.6, caused 2,698,000 YLL.
• The 1918 pandemic, with an estimated 1,272,300 deaths and a mean age of only 27.2, exacted a toll of 63,718,000 YLL.
• An average flu season dominated by influenza A/H3N2—which generally causes more severe epidemics than other strains—causes 47,800 deaths and 594,000 YLL, with a mean age of 75.7.

This week, the WHO committee reviewing H1N1 response may be weighing actions taken against the severity of the disease. But the focus will be on looking forward. Experts will be considering what lessons they can take from this past flu outbreak in order to anticipate and better plan for future pandemics and emergencies.