SHEA, IDSA call for vaccine emphasis in plan

The federal government's pandemic influenza plan lacks urgency in the area of vaccine development, which must be the linchpin to any public health response, two leading infectious disease groups warn.

The concerns are outlined in an Aug. 4 comment on the plan submitted jointly by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Disease Society of America (IDSA).

While conceding that a pandemic occurring in the near future would preclude consideration of a vaccine-based response, the groups emphasize that widespread use of a pandemic vaccine should be the central strategy for the protection of human health.

"While the plan addresses this issue, it does not sufficiently outline a comprehensive approach to vaccine development, production and delivery," the groups state. "New vaccine science and delivery approaches are needed with a rapid timeline for completion. Existing vaccine manufacturers must be actively involved. There is a critical need for rapid, transparent, and extensive exchange of scientific information among experts, and a novel systematic approach is needed to speed vaccine development."

The U.S. must take a leading role in fostering an international effort to develop the formulation for pre-pandemic vaccines and to prepare for the development, production and distribution of a global supply of true pandemic vaccines, the groups stated. SHEA and IDSA also underscored the importance of establishing working relationships with countries around the world, but especially within Southeastern Asia, in order to strengthen surveillance for a novel influenza virus.

"Without timely identification and notification of the presence of an evolving viral strain, our efforts to produce a suitable pandemic vaccine will be compromised," they warn.

The groups also questioned the plan's strategy for leadership and coordination, noting that an effective pandemic response hinges on clear chains of authority and coordination existing in practice, and our perception is that there is still a great deal of work to be done in this area. IDSA and SHEA urge that critical work move forward to demarcate lines of authority and decision making at the White House, departmental and agency levels, and from top levels downward."

In addition, they offered the following recommendations to further strengthen command and control interagency coordination:

a) continue holding cabinet-level, table-top exercises as an ongoing priority activity;

b) delineate the roles of the Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS) in those areas of potential overlap such as establishing reporting requirements and communicating with the public, and give strong consideration to tasking HHS as the lead in these areas;

c) delineate the roles of all federal agencies involved in providing support to state and local officials;

d) identify and involve appropriate technical experts and stakeholders, both within and outside of the government, to provide meaningful input into ongoing federal planning efforts.