US Department of Health proposes priorities for flu vaccine distribution

Draft guidelines issued by the United States Department of Health and Human Services in November have established a series of tiers and categories for distribution of scarce vaccine in the event of pandemic flu. These guidelines give strong preference for emergency responders, military and national security personnel, and socially important occupations, such as top politicians, energy sector and communications personnel, bankers, and newborn infants. Distribution of vaccine to the elderly occupies a low priority, especially in the event of a severe pandemic with a case-fatality rate of 2% or more causing more than 1.8 million deaths. The scheme differs significantly from that proposed in Britain in 2005, which gave high priority to the elderly, noting that most of the deaths in recent years - ranging from 12,000 to 29,000 annually - were in elderly patients.

U.S. 2007 Britain 2005Tier 1. Deployed/mission critical national security, health care providers, police, fire, vaccine manufacturers, top politiciansPriority 1. Health care workers, nursing home staffTier 1*. Pregnant women, infants (*Sub-tier plan places at lower priority than other Tier 1)Priority 2. Fire, police, security, communications, utilities, undertakers, armed forcesTier 2. Intelligence, border, national guard, other domestic national security, community support, electricity, natural gas, communications, water, critical government personnel, children, household contacts of infantsPriority 3. High medical risk (e.g. diabetes, immunosuppressed)Priority 4. All over 65 years of ageTier 3. Other active duty military, important health care, transport, food, banking, pharmaceutical, chemical, oil sector personnel, postal and other government, children Priority 5. Selected industries, e.g. pharmaceuticalsTier 4. High risk conditions, all over 65 years of agePriority 6. ChildrenTier 5. General publicPriority 7. General public

The plan is open to public comment under U.S. Federal Register guidelines until December 31.