DISCUSSION: What Can We Do Before Vaccine Becomes Available?

COMMENT THREAD

• How to give your comments MOST IMPACT
  

  Submitted by Nicholas Dewar   on 12/6/07 06:40 AM

  I know you want your contribution to this dialogue to have as much impact as possible. Here are some important guidelines:
  
  ACCURATE SUBJECT TITLE: describe exactly what you are going to discuss
  
  KEEP THE TEXT SHARPLY FOCUSED ON ONE TOPIC: if you want to describe something very complex, consider breaking it down into a series of sharply focused messages.
  
  KEEP THE TEXT BRIEF: More people will read your message if it is short.
  
  INTRODUCE YOURSELF: The first time that you make a contribution to the dialogue, start with a short sentence describing why you are so interested in Vaccination Prioritization for Pandemic Influenza (remember to keep it very short).
  

  • Insurance companies, stockpiling
    

    Submitted by Alec Glucksman on 12/6/07 06:59 AM

    I'm currently a senior in college and member of a group that promotes pandemic awareness and preparedness, Students Prep America (www.studentsprepamerica.org). My question has to do of course with preparation, specifically does anyone know the policy most insurance companies follow regarding stockpiling? As a cynic, I’d imagine that they would give no consideration to someone asking for them to cover “unnecessary” (not immediately necessary) medicine. This is important to know, and to handle on the federal level if there is not a system in place, since most Americans will not be able to stockpile life-sustaining medications effectively without the aide of their insurance companies. Food and water are necessary, but so are some peoples’ medicine—the insurance companies must have either some sort of legislation or something that requires them to cover stockpiling as they cover any typical medication.
    

    • Insurance companies, stockpiling
      

      Submitted by Eleanor Peters   on 12/6/07 07:41 AM

      Hi Alec -
      
      You have an excellent point. And unfortunately you are right. As far as I know, insurance companies are not allowing for the stockpiling of extra necessary medications. It is a big bummer when we talk to people and try to get them to prepare to have to say: "And keep your medications as current as possible" instead of "buy an extra bottle if you can"

      • Stockpiling meds.
        

        Submitted by Bill Pritchard on 12/6/07 08:09 AM

        
        How practical is home stockpiling for meds that need refrigeration but have relatively short expiration dates?
        

        • stockpiling meds at home, work or elsewhere
          

          Submitted by Brant Goode   on 12/6/07 08:55 AM

          Hi Bill,
          
          Individuals and groups are considering this option to help avoid a rush to the pharmacy during a pandemic. Some groups have identified processes to get the prescriptions written but are waiting to fill until closer to the pandemic--this helps with the shelf-life issue. One of the flu drugs has a 5 year shelf life at reasonable room temp.
          
          Methods to quickly distribute large volumes of medications and provide to large numbers of people is one of the tasks many emergency planners are looking at, developing plans to address and test.
          
          Brant

          • Which Drug are You speaking about?
            

            Submitted by Antanina Perricone on 12/6/07 09:40 AM

            
            Brant:
            
            Can you tell us which medication you are referencing?
            
            "One of the flu drugs has a 5 year shelf life at reasonable room temp."
            

          • how will they know what is "closer?"
            

            Submitted by Cindy Deutsch on 12/6/07 02:58 PM

            There is a problem with this.
            
            The H5N1 virus is acquring the changes needed to cause a pandemic.
            
            *It can survive in the lower temperatures in our upper respiratory tract -
            as opposed to the warmer temps deeper in our lungs. This means we can be
            infected more easily.
            
            *There has been human to human transmission.
            
            *It has spread across Asia, Europe, the Middle East and parts of Africa. So
            there are more opportunities for it to infect people.
            
            How will they know when it is closer? A pandemic could start next year, but it could also start tomorrow.
            
            Also our "just-in-time" delivery system means that we do not have huge drug company warehouses stocked with medications. They may find that there is no medication to be had if they try to fill prescriptions at the beginning of a pandemic or when something has happened that makes it appear close.
            
            The company that makes Tamiflu announced just this week that they are laying off over a hundred workers because they aren't getting orders. Why should they produce it if no one is buying?
            
            If you need something for a pandemic, you need it now.
            

        • Tamiflu does not need refrigeration
          

          Submitted by Ellen Rice on 12/6/07 12:25 PM

          Tamiflu has a shelf life of five year and does not need to be refrigerated

      • Antivirals ought to be over the counter
        

        Submitted by Ellen Rice on 12/6/07 12:24 PM

        It would help our nation prepare if Tamiflu was an over-the-counter drug. It is so hard to go convince a doc that you want to have this Rx on hand. Many people would stock it if they could just pick it up while they are at the grocery store.
        
        I can go out and buy a gallon of whiskey, a chain saw, a Hummer, a gallon of gasoline and box of matches. We trust adults with all sorts of things that have destructive potential. Why don't we trust the adults of America with a Tamiflu purchase?

        • Agree - Wish Tamiflu was Over the Counter
          

          Submitted by Deborah Robinson on 12/6/07 01:19 PM

          Ellen, I completely agree with you!!!! Roche, Tamiflu's manufacturer, might have already slowed its capacity (after ramping it up to meet world demand). I would LOVE to be able to get Tamiflu over the counter. I agree that we are trusted with many dangerous things; I think we can handle the responsibilities of Tamiflu.

          • Antivirals might be good candidate for behind the counter drugs
            

            Submitted by Mitchel Rothholz on 12/6/07 07:44 PM

            The FDA is having a dialogue on whether to designate some medications as "available from a pharmacist" or "Behind the counter." There would be criteria for how patients could access these medications. With the tight timeframe for getting these meds this coulod be an effective way for patients to access these meds.
            
            In regards to stockpiling, I am concerned with patients having stock in their homes that is not rotated, could go out of date, may not be stored appropriately, etc. The worse thing that could happen is a patient needing the med and it is out of date and ineffective (what a waste of resources).

        • Why is Tamiflu not over the counter?
          

          Submitted by Katharine Fisher on 12/6/07 01:37 PM

          If the federal government cannot buy enough for everyone (I would not expect them to) and the states either cannot or will not purchase Tamiflu for their citizens, we have to live with that I guess.
          
          But then why isn't Tamiflu made available - say rationed in limited quantities of one treatment course per person - over the counter?
          
          And why not do this now, while additional supplies can be produced and distribution is easy?
          

          • I am concerned about readily available tamiflu
            

            Submitted by Roy Kamen on 12/6/07 01:43 PM

            I think you'd need to address the "mental health" problems that they've seen in Japan where they've been using Tami regularly for seasonal flu.
            
            also are you concerned that people would just take their tami too soon... at the slightest sniffle?
            how about people who would hoard it then sell it for higher prices?
            
            There are many problems ... I read somewhere about a plan to distribute via the mail. Know about that?
            
            also my insurance company said they would only approve 1 course per person per year.

            • There are ways to make available
              

              Submitted by Mitchel Rothholz on 12/6/07 07:46 PM

              Have the medications available behind the counter with established protocol for how patients would be screened and counseled before receiving the medication

    • Many medications are made overseas
      

      Submitted by Katharine Fisher on 12/6/07 09:13 AM

      Alec, a further complication is that many of our standard medications (such as antibiotics) are made overseas in places such as India.
      
      When the supply chain breaks, foreign made medications may be the first critical casualty.
      
      Public health officials may plan for and set up distribution mechanisms that seem very effective - on paper - ahead of a pandmeic. But if the supply of necessary medications is interrupted, there will be nothing to distribute.
      
      As far as I know, no one is creating a stockpile of the kind of medications Americans use for chronic illnesses. The pharmacists I've spoken with are making the assumption that they'll not be at work because there will be no supply on their shelves to distribute.
      
      Unless federal policy is changed now, and insurance companies are mandated to allow at least a 90 day supply of prescriptions now, ahead of pandemic, how will the required amount of medications be available to the system later when manufacturing and distribution channels are interrupted?
      

    • Simple stockpiling
      

      Submitted by Joel Palmer on 12/6/07 09:19 AM

      What I have done and recommend is just refill prescriptions as early as possible under your insurance. I can usually get a new fill with a week or more left and after a couple of refills it builds up. This requires a shelf-stable medication.

    • Stockpiling
      

      Submitted by David Korpan on 12/6/07 03:10 PM

      If regulations require insurance companies to stockpile antiviral medications, they will pass the cost along to their clients (i.e. companies and individuals who purchase their insurance). The end result is that we all would be required to pay for the stockpiling. This would be a step in the right direction because it would push up the demand on the manufacturer. Currently, Roche is not producing Tami flu because of a lack of demand. However, stimulating demand and production is only one step. Distribution is currently restricted by rules on issuing prescription drugs to the public. How can we plan for timely and effective distribution prior to a pandemic event?

      • There are existing distribution systems that can be utilized
        

        Submitted by Mitchel Rothholz on 12/6/07 07:49 PM

        Pharmacies already have an elaborate distribution system utilizing drug wholesalers and manufacturers who can get the meds to community and other pharmacies for dispensing to patients, screening for interactions / contraindications and documenting receipt of the medication.

  • To limit the spread of a pandemic:
    

    Submitted by Diana Tolladay on 12/6/07 09:49 AM

    We must
    1. Have plans to deal with a variety of scenarios that may present themselves, including the severity of the pandemic, geographical quarantine, weather related expansion of the pandemic or the possibility of a natural barrier (as seen in the Bubonic Plague) that might afford us the opportunity to shift critical infrastructures and populations to.
    
    2. Provide the public with information, resources and reassurance during the isolation period. Information should take many forms but RADIO should be a primary concern , as many socioeconomically disadvantaged individuals may have had utilities shut off, no access to the internet or television after a brief loss of income due to illness, quarantine etc. However they will most likely still have access to Radio.
    

  • To prevent disease and death:
    

    Submitted by Diana Tolladay on 12/6/07 09:51 AM

    To prevent disease and death:
    
    1.We must be able to stay isolated from the influenza. Ellis Island was once used to keep individuals with diseases from entering the country. (Typhoid Mary Mallon http://www.pbs.org/wgbh/nova/typ...). Today with international airlines moving in and out of the country each hour a new, more efficient and perhaps even less offensive method of determining the health of individuals entering the country should be a serious consideration.
    
    2. Once the virus has entered the population here, the system of quarantine must snap into place immediately. The longer those in power drag their heels the more opportunity the virus will have of increasing in severity. Every person in charge of a critical function should have a back-up or two and as a preventative measure, they should not have contact with one another.
    
    3. Consideration should be given to natural barriers to the virus. By natural barriers I mean geographic areas whose weather may prevent the virus from spreading there, as it did with the Bubonic Plague in Japan, areas of the British Isles, and extreme northern Europe. If the plague is as sever as some predict. Our nations capital, and national security may need to consider moving to Alaska.
    
    4. Not a solution but a beginning - Families need to be encouraged to stock-up as a lifestyle. Advertising campaigns in the 50’s had bomb shelters, and disaster kits selling in storefronts from Sears to the local Hardware store. If families were encouraged to act and resources were readily available, people would buy into it and prepare. Kits with water purification systems and N-95 respirators should be sold next to generators, and or Band-aids in the local super stores. If its there – people will buy it.
    

    • To prevent disease and death
      

      Submitted by eric kelley on 12/6/07 11:47 AM

      We will not be able to totally do this and many will die. I agree with Everything you have said Diana.
      With suggestion #1, as we now go through security before any travel might the Health Dep set something similar to this and traige every person. Those traveling to where the outbreak is occuring may need to be stopped.
      
      #2 Would this require Marshel law? With today's average person I can NOT see them willing quarantining themselfs. It's difficult enough now to have people take their medications as ordered by their physician.
      
      #3 Agree and should be reviewed seriously.
      
      #4 This should be occuring NOW!!! Every few weeks I have purchased N95's.
      Also have begun storing food that has a shelve life of 2-3 years.
      
      To say the least this will affect each family greatly!! As others have already pointed out numerous people will not be able to work due to the disease and/or quarantine. I can't see having soup lines. What of the Army or the Guard delivering basic things to families in need? If they have no money and are out of food. After a few days of quarantine good luck with keeping teenagers and outdoors type people inside their houses.
      Marshel law will most likely be needed.
      We must begin NOW to plan to protect our family.
      Eric Kelley
      

    • Modeling suggests not to close borders
      

      Submitted by Ellen Rice on 12/6/07 12:33 PM

      There has been some modeling (MIT?) that suggests that influenza is not halted by border closures. This may be because a person can be infected and shedding the virus BEFORE they show any symptoms. This means that to be effective, you close all borders immediately once there is a case elsewhere in the world. We did not leap to close borders when H5N1 went human-to-human for the six cases in Karo, Indonesia. That cluster just snuffed out (perhaps because of Tamiflu given to neighbors, etc).
      
      There have been a number of documented human-to-human transmitted cases of H5N1. Most of the world doesn't realize this -- and most of the world would be angry and appalled if the borders were shut every time there was a tiny cluster.
      
      What we don't know is when a tiny cluster will explode into a big deal -- and by the time we figure that out, a passenger will already be debarking at La Guardia with the virus in tow.
      
      Try visualizing telling any business person in your town "You need to take your children out of school today and stay home for six to eight weeks because we have human-to-human H5N1 transmission in Turkey". Not gonna happen. We DID have human-to-human cases in Turkey last year and the U.S. didn't even yawn -- much less close any borders.
      

      • and if Mexico closes the border to the USA?
        

        Submitted by Diana Tolladay on 12/6/07 03:36 PM

        What if Mexico closes its border to us, adn the people from Mexico are trapped here - undocumented. .. how will they deal with the issues, and how will we deal with them?
        
        or Canada

  • To lessen the impact on the economy
    

    Submitted by Diana Tolladay on 12/6/07 09:52 AM

    To lessen the impact on the economy:
    We must have
    1. Electricity
    2. Postal/ Shipping and receiving services for everything from paying bills to receiving food, medications
    3. The government must freeze wages along with prices of goods and services, so that the general population can maintain the flow of money.
    4. Grocers (Super Stores) should have a system in place to deliver foods and sundries to families. Orders for goods should be able to be placed over the phone. Payment should be accepted over the phone for a gallon of milk as easily as it is to make a utility payment. Perhaps the time has come for the return of the milkman. Imagine how positive the psychological effect would be if families knew they can establish home delivery.
    

  • To keep society functioning:
    

    Submitted by Diana Tolladay on 12/6/07 09:55 AM

    We must have
    1. Electricity
    2. Water
    3. Sewage and refuse removal
    4. Food
    5. Non-influenza related medicine /sundries e.g., toilet paper, soap etc.
    6. Information on a regular - reliable basis.
    7. A sense of security (or at least the illusion of it)
    8. Students must have access to education. While not all students have computers and access to the internet, those that do could be ((( constructively occupied ))) learning during the isolation period, if a system were in place to offer lessons, projects, etc. Beyond the obvious preservation of civilization that education provides, the economic stability of many communities depends on the functioning of school systems. It would also provide stress relief to the parents caring for the bottled up youngsters.
    

  • Social Distancing of Teenagers
    

    Submitted by Diana Tolladay on 12/6/07 09:59 AM

    A concern of mine is the Social Distancing of Teenagers and young adults who can and will compromise the integrity of any isolation/quarantine to be with friends.
    
    
    I am a teacher. Daily, I see the side of students that parents rarely if ever do. In a previous unit we discussed the 1918 Influenza Pandemic. Students overwhelming laughed at the idea of carrying a hanky, wearing a scarf over their faces, staying home if ill, and not visiting with their friends on a daily basis. In fact, many claimed they would sneek out of the house even under quarantine circumstances.
    

    • My Space, Facebook, and U Tube
      

      Submitted by Katharine Fisher on 12/6/07 10:07 AM

      One difference between 1918 and today is that teenagers have come to rely on various social media as part of their daily lives. For many, My Space, Facebook, and U Tube are as necessary as the air they breathe.
      
      While most of us parents roll our eyes and consider the wired social media a big waste of our kids' time, it could prove a vital life saver for this age group when pandemic comes.
      
      If we can keep the internet up, and not restricted in its use, teenagers and young adults may find that the (likely increased) lively environment online may make up for their real social shortfalls. Hopefully, with this in mind, efforts will not be made to restrict internet use unless it becomes absolutely necessary.
      
      And besides, who knows what our youth will produce as a result of their home isolation? During the Black Death, writers such as Boccacio and Dante penned some of their finest work while sheltering-in-place in the countryside to avoid contagion. What our young people create with the electronic tools available to them today in a simliar situation may boggle the mind (both on the good, and the bad end of the spectrum!).
      

      • Like Students Prep America - facebook group?
        

        Submitted by Roy Kamen on 12/6/07 10:27 AM

        http://www.facebook.com/group.ph...

      • Death is an educator too
        

        Submitted by Ellen Rice on 12/6/07 12:37 PM

        Teens are not dumb. If the TV news is showing dying people, it will result in attention. I read one elderly lady's recollection of the 1918 flu. She said that her mother made her and her sisters play only in the back yard and no child could answer the door. People were dying on their street. The kids knew that. The kids listened -- and survived.
        

    • Parenting Techniques
      

      Submitted by Willie Hearns on 12/6/07 10:17 AM

      I don't think that anyone would argue the fact that our children are a direct reflection of parenting. Parents need to actually discuss the pandemic and the ramifications of it, to their children. Not to scare them, but to educate them. Yes it's true that teenagers are rebellious, but common sense must prevail in a situation like this. Dare I say it, but this might produce a Darwinistic effect in the teens.

      • Will they level with the teens?
        

        Submitted by Katharine Fisher on 12/6/07 11:02 AM

        If our government is worried about "panicing" our people with scary tales of what a pandemic could be like, can we really expect the parents of this nation to do any better and be more forthcoming?
        
        It's like the old telephone game - I fear that every time the story is told, it is watered down.
        
        The story that is told in the Executive Office of the President today, or on the day pandemic begins, is one that is and will be very different from that told to the varying levels of our agencies, the states, local media, families, parents, and eventually our teens. Each level removes a part of the "scary" reality, it seems, in an attempt to protect the next level from panicing.
        
        This is not working so far, and won't work during a pandemic. Our officials are too busy acting in loco parentis for us. Parents do this as a job requirement. Risk communication messaging that is too mild and which hides reality serves no one in the end.
        
        You don't think this is happening? I'll bet that if you put just one day's Pandemic Progress Report (or whatever it is titled) just as it lands on the desk of the President on the front page of the New York Times that it would curl your hair.
        
        The message is being diluted as it drips down the ladder. The funny thing is, our teens and young people tend to be truth tellers and fearless in a way that can often be a good thing. Once the reality hits them, if anyone will share it with them, I think they'll be more ready than most of us to deal with it.
        
        The organization that appears here today, Students Prep America, is a fine example of that willingness to address the facts, and do something about them. Very admirable.
        
        I'll bet our teens and young people will step up to the challenge in many places, if the message reaching them is not a milquetoast one.
        

    • Survivors will have a different view.
      

      Submitted by larry wright on 12/6/07 11:33 AM

      Think of it as evolution in action.
      
      If I had a teenage child, and I were not absolutely sure that they would obey a quarantine/SIP order that I issued, I'd ensure they stayed in by any means neccessary- wrap them in a wet sheet and tie them to a bed frame if I had to. Alternately, I'd tell them that if they left the house they could NEVER return, but in any case I would enforce an isolation order for the sake of the rest of my family.

  • Teenagers on Cell Phoines
    

    Submitted by Diana Tolladay on 12/6/07 10:01 AM

    Another major concern should be the overload of communications systems by individuals making unnecessary calls (remember the millions of children who have cell phones).
    
    Has any thought been given to turning off cell phones of children during the crisis so emergency personell can have clear, unhindered access?
    

    • WOW - great idea i never thought about
      

      Submitted by Roy Kamen on 12/6/07 10:15 AM

      Diana gets my gold star for today.
      
      When this thing hits, it'll be a good idea to "turn off" those non-essential cell phones.

      • Excellent!
        

        Submitted by Catherine Jackie Mitchell on 12/6/07 10:16 AM

        I never would have thought of that either...
        
        Great Diana!

    • Actually this issue is being looked at...
      

      Submitted by Terry Adirim   on 12/6/07 10:20 AM

      I'm not familiar with the details, but one concern is that if people (who can) are asked to telecommute and work from home that this could cause problems for the system. It is called "the last mile" and there may not be enough capacity to handle the on-line traffic.
      

    • Will not work
      

      Submitted by Willie Hearns on 12/6/07 10:23 AM

      The idea is great in concept, but it's implementation would be a nightmare. You are asking cell phone providers to try to sort through their customers and turn off selected phones. Emergency personnel whould focus more on compatible radio systems, than unreliable cellular coverage.
      
      In MS, during Hurricane Katrina, cell phone service along the coast was brought to a standstill. Most towers were destroyed, and those remaining were simply overloaded, by both the young and the old callers.
      
      Let's look for alternate communication methods instead.
      

      • its the parents job
        

        Submitted by Roy Kamen on 12/6/07 10:43 AM

        I'd ask the parents to do it.

        • Parents aren't as disciplined as we think.
          

          Submitted by Diana Tolladay on 12/6/07 03:49 PM

          And these would be the same parents that call students while they are in class to see what they would like for dinner. (yes it really does happen) Expecting them to act rationally as the panel is expecting miracles.
          

      • The Old Ham Radio systems. Sat Phones?
        

        Submitted by Diana Tolladay on 12/6/07 03:46 PM

        The Old Ham Radio systems provided communication long before the advent of cell phones but there are relitively few people that own them or know how to operate them today.
        
        I expect the government, military and national security to have access to Sat Phones, but that won't help the guy on the ground trying to call an EMT.
        
        If cell phone companies aren't professionally organized to know whether the phone line is linked ato a 10 year old kid or a 50 year old nuclear engineer then my suggestion is that they figure it out now adn establish a system by which a certain prefix has priority or another can be shut down for emergency purposes.
        

        • HAM radio personnel included in many plans
          

          Submitted by Sharon Hutchins on 12/6/07 04:46 PM

          Diana's idea of HAM radio is a great one and is in fact already incorporated into a number of emergency plans I know of. Our county routinely exercises (several times a year) with two different radio clubs. They have helped us and hospitals select good equipment and helped to train on its use. One problem, however, is that most club members are older -- few younger people are interested these days it seems.

    • Priority phone access for responders
      

      Submitted by Sharon Hutchins on 12/6/07 04:44 PM

      Diana, there is a program (for both land lines and cell phones) where certified emergency personnel/government agencies can get priority access in a crisis. This has been used after hurricanes, earthquakes, etc. It does not guarantee access, but is helpful!

• Educate NOW, Educate NOW, Educate NOW
  

  Submitted by MoMos Mom on 12/6/07 07:47 AM

  During the six months when Americans are falling ill and there are not enough anti-virals and there is no vaccine, it will be of paramount importance to keep the electrical grid up.
  
  If the grid goes down, there will be a lot of collateral damage that will increase the 2% CFR that is expected by current planners.
  
  How will diabetics keep their medications refridgerated?
  How will cancer patients continue to get their treatments?
  What will happen to the people who need medical attention for non flu related illnesses after the first 14 days when the hospitals are over run?
  How will we get supplies that are imported in if the exporting country is too busy dealing with disease to send them?
  What will the mental status of unprepared Americans be? Post traumatic stress disorder? Defeated? Trapped? Angry?
  Do we have enough supplies stockpiled to keep the electrical grid going if we can't easily get the part?
  How will people in cities get food if trucks are not running, or our export countries decide to keep the food for their citizens because of the illness?
  What happens when local planners, who have been told that there will be no outside help, finally realize that the Strategic National Stockpile does not have enough anti-virals or food and that there is no way to get the food everywhere at once?
  What happens to Americans when moms and dads can't feed their children?
  
  It will fall to the communities to band together and try to help one another out. We will be facing this pandemic with the same science that they faced the one in 1918 with. What happens to inner city communities when they run out of resources? The people will be forced to abandon the inner cities and begin to move outward in order to look for food and other resources. History has shown us that 3 days after the power goes out that civil unrest and disorder will become the norm.
  
  Scientists do not know when a pandemic will occur. It could be H5N1, or it could be something else. It is self-defeating to not look at the science that says a negative RNA strand virus can use recombination to form a new strain rather than just reassortment. The new evidence that Ebola, also a negative RNA strand virus like the influenza virus, was shown to be able to do this this summer should have been eye opening to scientists. When Doctors described being shocked and surprised that the Adenovirus-14 had mutated into a form which caused a CFR of 25% in the Pacific Northwest and that other hospitals were seeing fatalities from this, that should have been a wake-up call that the known unknowns might not be what we think they are.
  
  The federal government seems to be putting all of its eggs into the vaccine basket while ignoring that our current vaccine production is egg based, which we have to have chickens to produce eggs. We seem to be ignoring the fact that vaccine production can only produce so much vaccine in a week, that we don't know if the strain isolated will still be well matched to the pandemic strain after the 6 to 9 months it takes to start getting vaccine out and rolling, we don't even know if the second wave of the pandemic will be the same strain of flu as the first wave. Flu viruses have been shown to make 20 - 40 mutation per year.
  
  The federal government needs to put its eggs in the basket of the American people. The government needs to ignore big business and lobbyists and educate the American people about what could happen, about what might happen, and about what we can do NOW to become prepared. It takes a while to process this information, to have several adjustment reactions to it, and to move on to what we can do. Congress, Democrats and Republicans, need to lead the nation and not just react to polls. There needs to be a clear message that Americans need to become self-sufficient and more self-reliant. We need to replace our current mantra of spend, spend, spend to one of how can we harden our civilization and produce more goods here.
  
  I think that the American people will surprise and shock you. Put your faith in the American people instead of in some vaccine that may not be there. Educate and educate NOW rather than in a time of crises. Run PSAs that get people to go pandemicflu.gov and other pandemic flu web sites. A culture of preparedness should be touted and hailed as a good thing. Encourage people to have victory gardens in and out of the cities. Encourage the exploration of alternative sources of power. Wouldn't it be nice if our GDP changed from being 76% consumer spending to other nations to a GDP that produces energy to export to other nations?
  
  Educate and engage. Without a doubt, America is the greatest nation on this planet, and our best resource is our people. Give people the information that they need to make sound decisions. Say you don't know when you don't know. Recognize that even one American may tip the scale of knowledge and find the solution. LEAD. Don't follow.
  

  • LEAD. Don't follow
    

    Submitted by Catherine Jackie Mitchell on 12/6/07 07:56 AM

    What can be added to this articulate cry from the heart? Kudos to you!

    • Educate NOW
      

      Submitted by Alec Glucksman on 12/6/07 09:04 AM

      I wholeheartedly agree with Momos Mom. If the public knows what to do in the event of a pandemic, there will be no need for a vaccine that will come 6 months after most of what we're worried about occurs.
      
      Part of being prepared and educated, however, is having consistent sources. If you're sources don't match up, especially when they're coming from the same government, you lose so much credibility. Dr Schwartz in the video briefing to this forum discussed that the first wave of a pandemic would probably last 6-8 weeks, that voluntary quarantine should be the norm for anyone affected, and that people should prepare supplies of essential food, water, and medications. Why is it that the CDC then links in the library resources for today's discussions to a US Dept of Health and Human Services talking point sheet that says people should only stockpile for 2 weeks? It doesn't add up, and it must. We have reason to believe that we must prepare for at least 3 months; to have an organization in our government saying otherwise is detrimental to the preparedness cause.
      

      • Consistent message from Gov.
        

        Submitted by Roy Kamen on 12/6/07 09:10 AM

        Alec is right. On one hand the Gov says school closures and home quarantines of up to 90 days to make it through a pandemic wave lasting 6-8 weeks in a community.
        
        But then HHS goes on to say stock up for 2 weeks.
        
        I dont blame the public for being confused. I would be too if I didn't do the research and read the Gov docs.

        • Step One - Tell the public that there is no vaccine
          

          Submitted by Katharine Fisher on 12/6/07 09:39 AM

          In recent months, many localities have run some very successful mass vaccine dispensing drills. CDC has both mandated and funded this activity.
          
          When a mass vax clinic is held, inevitably it gets local press. The public health officials are often glowing in their assessments of how things went (and usually, they have gone very well). Frequently these clinics have also takent the opportunity to distribute seasonal flu vax.
          
          When the newspapers write up the story of these local clinics, invariably a public health official will note that they are going being undertaken to help ready the area for a pandemic influenza. They then often remak that when pandemic influenza occurs, they'll be ready to vaccinate hundreds of people in X amount of hours, with the whole town or county being covered, mathematically speaking, in X number of days.
          
          The public health officials seem happy, the newspapers seem happy to report on the happiness, and nobody asks any further questions.
          
          Of course, what's been left out of all these stories, which have been run from Palm Beach, FL, to Wilton, CT, and all over the rest of the country, is that there are a few problems with that cheerful panflu vax scenario as it is being presented (or as it is being allowed, by implication, to be presented).
          
          Clearly, the reports of the public health officials doing these mass vax drills are misleading when they report that they'll be ready to vax their citizens "within 72 hours." No one asks "within 72 hours of what?" and the implication then stays with the public that they mean "within 72 hours of pandemic onset" rather than "within 72 hours of our receipt of vaccine."
          
          Of course, when that "receipt of vaccine" will be is the bugaboo question.
          
          The public is completely unaware that, in reality, pandemic onset could be in March, the head of the ER at their local hospital may not be vaccinated until September, and that limited allocations of the vaccine mean that they and their family may not be vaccinated until January of the following year. Of course, that will be within the "72 hours" that the public health officials are so proud of, but that little footnote that it will only happen 9 months later, and in the following year, is always, without exception, the detail left out of these local newspaper stories.
          
          I have read hundreds of these local stories on mass vax clinics in preparation for a flu pandmeic. That's why they say they're doing them in the first place. The implication for our fellow Americans is that a vaccine is going to be available, and that their public health officials are well prepared to get it to them in an orderly and timely fashion. Of course, this could not be further from the truth.
          
          Further, not one mass vax scenarios I have read about has addressed the concept that only one demographic cohort or one worker category cohort will be allowed to appear for vaccination on the appropriate day. The implication given is that once vaccines are available, it's the general public en masse who will be asked to show up for their shot at these clincs since that's the way they are being practices at the local level.
          
          Again, our citizens need to be disabused of this notion, and swiftly. I'm not sure how easy it will be to do this, however, after all the "mass vax for everybody (hundreds at a time - get on the busses and let's all go to the High School) within 72 hours of the onset of the problem" message has been promulgated over and over.
          
          I know CDC and HHS and other agencies have hired risk communicators. They should all be fired. So much damage is being done by misleading the public about basic truths about what we know will happen. There will be no vax "within 72 hours." There will be no timely mass vax clinics for the general public. It's time to stop putting out the bunk and tell our citizens the truth. It's going to take time to fix these misconceptions, and it's going to take time to educate them as to what to really expect.
          
          Start now. And stop the disinformation as soon as you humanly can.
          

          • Everyone will show up on day one of a vax distribution
            

            Submitted by Roy Kamen on 12/6/07 09:47 AM

            I know that if word got out that vaccine was available the place would be mobbed.
            
            When do we discuss the actual communication of the distribution?

            • Correct - the public will expect that the vaccine is for them
              

              Submitted by Katharine Fisher on 12/6/07 10:00 AM

              It's going to be difficult to explain to them that vaccine quantities are limited and what's there is not meant for them. Security considerations may be significant.
              
              Communicating the reality of the situation may be a difficult and unwanted job that many are avoiding. But I'd rather do that than run security at a mass-vax clinic that isn't mass and doesn't have enough vax than for more than a few pre-selected people.
              
              Sometimes I think that our public health officials are just not thinking things through.
              

              • PH workers are not thinking things through
                

                Submitted by Roy Kamen on 12/6/07 10:17 AM

                and its unfortunate that they have labeled us as bird flu loonies.
                
                we are a wonderful resource and we are FREE. hear that PH - WE ARE FREELY OFFERING OUR SERVICES.
                
                of course i am speaking for myself as I have 3 kids to save.

                • Sticks and stones
                  

                  Submitted by Catherine Jackie Mitchell on 12/6/07 10:24 AM

                  Sticks and stones right?
                  
                  I just hate to generalize and stereotype. Perhaps they just needed to have tons of time to sit at a PC and learn all this stuff? No judgements...this is life...mistakes happen. Now that we have informed their discretion, however..... ;)

                  • Problems from on high
                    

                    Submitted by Roy Kamen on 12/6/07 10:28 AM

                    The APHA says - 3 days, dont worry, be happy. Why should the local PH say otherwise?

                    • tough row to hoe
                      

                      Submitted by Catherine Jackie Mitchell on 12/6/07 10:42 AM

                      tough row to hoe when the truth comes out....and it always does....one way or another.
                      
                      That thought prompted me to action three years ago. How could I look my neighbors in the face and say "i did not know". I just can't do it.
                      
                      The best, most freeing feeling that I have felt in a long time was when I went door-to-door and told my neighbors. Truth has a refreshing quality to it....kind of makes you soar.
                      
                      Then I fell on the ice....another story for another day :big smile:
                      
                      TRUTH TRUTH TRUTH TRUTH TRUTH TRUTH TRUTH TRUTH TRUTH TRUTH TRUTH

                    • APHA and CDC rule
                      

                      Submitted by Katharine Fisher on 12/6/07 11:11 AM

                      If APHA says 3 days of emergency preparations are needed, and CDC and HHS say just 2 weeks of emergency preparation are needed, that's what public health officials will say is needed. I can't really blame them.
                      
                      To break this impasse, public health needs to engage in forming the Pandemic Preparedness Coordinating Committees, involving all interested community stakeholders, just as was initially recommended by our leaders in 2005. http://www.pandemicflu.gov/plan/...
                      
                      If this is done, communities will be able to find their own solutions, and solutions that are appropriate to their communiities.
                      
                      But that means setting up those Pandemic Preparedness Coordinating Committees and letting non-traditional stakeholders join the discussion. New territory, maybe for public health, but they're the ones who are going to be under tremendous pressure during that prolonged period between pandemic start and vax. They should be the first in line seeking to share that burden.
                      

              • Remember the lines just a year or so ago when
                

                Submitted by Diana Tolladay on 12/6/07 03:55 PM

                Remember the lines just a year or so ago when the media said there would not be enough flu vaccine to go around. Here where I live when there was a flu clinic people stood in line for hours. Elderly people collpsed. At least 2 died and hundreds were turned away because they did not fit the qualifying categories or because the clinic had run out. And I live in a small rural community of 50,000 Imagine whatthis would be like in a much more populated area.
                

            • Communication
              

              Submitted by Joel Palmer on 12/6/07 11:31 AM

              I have a feeling that there will be no communication. People will show up to work and there will be nurses waiting to stick them and officials waiting for them to sign non-disclosure forms. At least for the initial set.

              • What would they be injecting them with?
                

                Submitted by Cindy Deutsch on 12/6/07 12:40 PM

                What would they be injecting them with?

          • Mass Vaccination Misconceptions
            

            Submitted by Willie Hearns on 12/6/07 10:38 AM

            These vaccination sites that are being referred to are called PODs, short for Point of Distributions. These are the locations where the public will be able to receive their medications. Everyone must understand, that at this time, THERE IS NO PANDEMIC INFLUENZA VACCINE. To develop a vaccine you must first have a strain of that virus. Current vaccines may offer limited protection, but not to the point of where they are being marketed as Pan Flu Vaccines.
            
            For our sites we use a 48hr time frame. Without going into specifics, the initial 12 hrs are used to set up the pre-designated locations and get the meds. The remaining 36 is used to issue vaccines or prophylaxis. There should be several locations, so that the public as a whole can be seen within that time.
            
            If your local authorities are not making plans such as these, they should be. That is why this forum is so beneficial,...to identify weaknesses and pass off ideas.

            • Fast POD response - in theory
              

              Submitted by Katharine Fisher on 12/6/07 11:17 AM

              Willie, may I ask if you believe that sufficient antivirals will actually come through to your PODS when the time comes?
              
              We know that vaccine will not come through in sufficient quantities (that's what we're here to deal with and help prioritize).
              
              My public health officials believe that their POD distribution plan is a good one, and it won't fail. They are organized. But what's missing seems to be a realization that what they are waiting for might not arrive in the quantities they are expecting. This would leave us with a beautiful POD distribution plan, and everyone standing around empty handed.
              
              What is your "Plan B" for such an evenuality. My district public heath office seems to have none. I think that's a bit of a fly in the ointment.
              

              • Going to get ugly
                

                Submitted by Willie Hearns on 12/6/07 11:41 AM

                Katharine,
                
                This is an issue that we too are addressing. We're not fooling ourselves into believing everyone is going to receive treatment. We are kicking several ideas around the table. They range from opening in a central location, "and once it's gone, it's gone" until the next shipment, to maybe rotating through different sites. The bottom line is it's going to get ugly really quickly. Everyone becomes supremely important when neccessities are limited, or at least that's their thought. This is going to be a sensitive issue for a while.

                • Pressure on government
                  

                  Submitted by Katharine Fisher on 12/6/07 01:50 PM

                  People need to understand now that there will be shortages then.
                  
                  Not just to help them deal with the new reality calmly. But ours is a government "of the people" and only if the people understand the particulars of any threat, can they do anything about that threat.
                  
                  Right now, no pressure is being brought to bear by our citizens on their elected representatives to fund modern vaccine development or purchase an adequate supply of antivirals, antibiotics, and PPE ahead of a pandemic.
                  
                  Citizens don't know the full story of the risks that may lie ahead, so there's no need in their minds to push for more of their resources to be used on these vital items. As long as our representatives do not hear the clamor for more of these things, there will be no more. There is no clamor because people are unaware of the risk.
                  
                  The shortages, in this case, will all be man-created. That is going to be very unfortunate, as seen through the eyes of historians looking back on this pandemic in the future. Much of what we will suffer will, in the end, seem to have been very preventable.
                  
                  With concentration of our considerable efforts and resources at the creation and manufacture of vaccines using newer-than-1950's technology, we could save ourselves the entire exercise we've just gone through here of prioritizing a vital, life saving, and absolutely critical resource we have simply made the conscious decision not to make enough of.
                  
                  Really, we shouldn't even be asking the question that is the premise of this dialogue.
                  

              • what would the PODS distribute?
                

                Submitted by Cindy Deutsch on 12/6/07 12:55 PM

                Where would they get the antivirals to distribute?
                
                We are only planning on the federal government purchasing enough antivirals for 15% of our population. They were hoping that states would purchase enough for another 10% of our population. Most states did not make the purchase. So we do not have enough for 25%.
                
                The dosing is being doubled and the length of time that the meds are being given is being doubled. That means that the 25% we hoped we would have is now only 6.25%.
                
                Even if we ignore the higher dose and longer length of administration, we will only have enough for something between 15% and 25% of our population. that will be used for people who are infected.
                
                If there is anything left for prophylaxis - given to prevent the flu - it will be given to healthcare workers, military, critical infrastructure workers. All of those groups add up to more than 15% of our population.
                
                We aren't going to have anything to distribute in PODS unless someone - federal or state government - buys massive amounts of antivirals. It would take hundreds of millions of doses.
                
                The company that makes Tamiflu actually just laid off 125 workers because no one is ordering the drug.
                

            • PODs
              

              Submitted by Joel Palmer on 12/6/07 11:35 AM

              Again, PODs are part of the CRI bioweapon program and not currently intended for pan flu. As a pandemic planner in a city running a CRI program I can say that with certainty. The POD system works under what is called a "non-medical model" where non-medical personnel pass out pills quickly to provide prophy for a bioweapon. Vaccines cannot be delivered this way because they are shots. If PODs have been presented as an anti-pan flu measure someone messed up.

              • Medical Volunteers
                

                Submitted by Willie Hearns on 12/6/07 12:13 PM

                We recruit medical professionals to staff our PODs. Doing this will make things faster, and cut down on errors. Agreed, the PODs were initially set up to dispense for other incidences, but it can also be used for pan flu. As scary as it seems, you still have to pass out the vaccine when it becomes available.
                

              • Joel
                

                Submitted by Cathy Pinette on 12/6/07 12:22 PM

                I am under the impression that our local POD will save us, at least that is what I am hearing.
                
                We have a POD plan for vaccinations but not enough volunteers.
                
                I suppose it won't really matter since the vaccine will come in spurts and only certain groups will be vaccinated.

                • Volunteers
                  

                  Submitted by Willie Hearns on 12/6/07 12:36 PM

                  A lot of people are willing to volunteer, they just don't know how. MS Dept of Health has a dedicated Volunteer Coordinator, who's job is managing the volunteers. The key to getting more volunteers, is to get more information out there.
                  
                  I attempt to recruit medical professionals from every clinic I speak with.

                  • Inform - Educate - Empower
                    

                    Submitted by Catherine Jackie Mitchell on 12/6/07 12:43 PM

                    Inform---gov't response
                    Educate---citizen grassroots response
                    Empower---citizen response

              • terminology
                

                Submitted by Catherine Jackie Mitchell on 12/6/07 12:32 PM

                We actually have a mass dispensing site planned for and we are not expecting a POD. You are right that we should be careful about our terminology.

              • terminology
                

                Submitted by Catherine Jackie Mitchell on 12/6/07 12:32 PM

                We actually have a mass dispensing site planned for and we are not expecting a POD. You are right that we should be careful about our terminology.

              • some states are planning PODS for panflu
                

                Submitted by Cindy Deutsch on 12/6/07 12:46 PM

                At least some states are planning on using PODS for pandemic flu.
                
                Pennsylvania is planning on PODS for panflu and they are talking about injections. Injections could be given in a POD situation - if there was something to inject.

              • PODS are always presented as an anti-flu measure
                

                Submitted by Katharine Fisher on 12/6/07 01:56 PM

                PODS are always presented by public health officials as an anti-flu measure.
                
                They are my state's key anti-flu measure (even though they have not ordered their recommended allocation of antivirals with which to stock them).
                
                At a big pandemic flu conference for hundreds of public health officials from around the State of CT, PODS were featured as key in their strategy. PODS will save the day when the SNS material reaches them within 48-72 hours of pandemic onset. That's what they said. And plans for distribution from those PODS are super-secret but we are assured that the distribution from them will be well organized and professionally run. Volunteers to help are being called for.
                
                They also think that their allocation from the SNS will give them everything they need for the duration of a pandemic.
                
                Sigh.

              • PODS vs mass vaccination
                

                Submitted by Sharon Hutchins on 12/6/07 04:56 PM

                Joel, many use PODS and mass vaccination campaigns interchangeably. We just billed one of our seasonal flu drive through clinics as a POD.
                
                I don't think, however, than many if any PH jurisdictions are contemplating distributing anti-viral meds (e.g. tamiflu) at PODS/vaccination clinics - just vaccine if/when we get it.

          • Error in stories about mass vax
            

            Submitted by Joel Palmer on 12/6/07 11:29 AM

            I don't know about the mass vaccination clinics in your area, the ones run in MD were testing a different program (bioterror related) and not pan flu. The program they are a part of is designed to administer prophy to communities potentially hit by a bioweapon within 48 hours of exposure. Some of the local health departments (who are included in the program) used seasonal flu shots as a way to test their proposed distribution models.

            • PA does plan PODS for panflu
              

              Submitted by Cindy Deutsch on 12/6/07 01:02 PM

              There have been organizations in PA who have used flu shots in the tests that you're describing.
              
              But official PA plan is that they will be using PODS for vaccine and antivirals.
              
              They have locations chosen, detailed plans worked out and they are calling them PODS.
              
              There's a lot in our plan that's odd - to say the least.
              

            • The press is hearing mass vax clinic = pandemic practice
              

              Submitted by Katharine Fisher on 12/6/07 02:05 PM

              Local press always reports that our mass vax clinics are being run to help with preparing for a pandemic mass vax situation. That's exaclty what the pubic hears, and apparently that's what our local pubilc health officials believe. They foonote that this is good experience for any bio incident too, but the press always reports on some public health official saying that this mass vax clinic will be just the sort of thing we'll be needing during a pandemic and that the vaccine will be here and ready for this organized distribution within 72 hours.
              
              Then the public health folks smoosh hundreds of people together in buses or in gymnasiums for their shots and visions of Philadelphia bond parades circa 1918 go floating through my mind.
              

              • Mass Vax DOES equal Pan flu practice
                

                Submitted by Karen Rose on 12/6/07 03:23 PM

                When the vaccine does become available, mass vaccination sites or POD's are the way to get it out. Our County PH Dept. has a plan for drive thru POD's, to avoid what you mention about the mass-infecting at the mass-immunization sites. We practiced a drive thru POD at a local high school with PO meds as opposed to injectables, and we could distribute very successfully. A local hospital here recently held a drive thru flu clinic and gave about 3,000 doses very efficiently.
                Practicing vaccine distribution on a large scale is a key component of preparedness. By practicing, we have learned from our mistakes and will be more efficient in the future. And we have learned key things like how very important it is to have adequate security on site to protect the medication and the providers of that medication.
                However, the fact that the public does not realize that there will be nothing to give them for 6 mos. is the main point here. We need to educate the press. They usually like scare tactics, so it seems strange they have not picked up on this one.