Dec 12, 2007 (CIDRAP News) – As US officials wrap up efforts to gauge the public’s response to a draft plan for allocating vaccine supplies during an influenza pandemic, suggestions to fine-tune the plan are emerging, such as giving higher priority to critical infrastructure workers, the families of key healthcare workers, and community pharmacists.A 3-day Web dialogue, held Dec 4 through 6, drew about 420 people who either participated in or observed guided discussions on various aspects of the pandemic vaccine prioritization draft, according to summaries of the dialogue posted on the event Web site. The event was sponsored by the US Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), along with the Association of State and Territorial Health Officials (ASTHO) and National Association of County and City Health Officials (NACCHO).The groups, with assistance from the Keystone Center, a nonprofit science public policy group based in Keystone, Colo., will hold a stakeholder meeting in Washington, DC, tomorrow. They also sponsored a series of public engagement meetings in January in Las Cruces, N.M., and Nassau County, N.Y., and in November in Milwaukee and Henderson County, N.C. HHS is taking comments on the draft pandemic vaccine allocation plan through Dec 31, according to a Federal Register notice.A federal interagency working group presented its vaccine prioritization draft to HHS’s National Vaccine Advisory Committee on Oct 23. The tiered approach lists key health and safety personnel and children as top priorities.During the Web dialogue, participants offered several ideas for revising the draft guidance, according to daily summaries on the dialogue Web site. Some suggested that adding an age criterion to the occupation groups might help the plan fulfill its goals of reducing deaths and maintaining critical infrastructure. “It was noted that the draft guidance is not age-based, but leans more toward protecting society (critical infrastructure) and the population groups at the top [of the priority lists],” the summary notes.One of the main themes, according to the daily summaries, was protecting critical infrastructure, especially the electric power grid. Employees who maintain electrical systems should be moved to the top tier, many of the participants said.”Some suggested that the only true critical infrastructure is electric power,” the dialogue summary said. Employees who maintain power systems “should receive the highest priority for prophylactic antiviral medications, have special support for their families, and be first in line for vaccine,” the summary noted.The vaccination priority of family members was also raised several other times during the Web dialogue. Though many participants seemed to support family coverage for first responders and other key healthcare workers, there was less of a consensus on priority status for the families of military members and homeland security employees. Some surveys have indicated that many healthcare workers will not show up for work during a pandemic if their families don’t receive antiviral medication or vaccines and if they don’t have adequate personal protective equipment.Some participants said the final vaccine priority plan should factor in important supply chain issues and protect workers who produce and deliver necessities such as raw materials, medicine, food, and fuel.The discussion moderators asked participants what the government should do to make the vaccine priority plan more acceptable to the public. Suggestions included keeping citizens informed when supplies of vaccines and antiviral medications change. “Citizens will be enraged if their expectation is not adjusted before a pandemic starts. Set the policy for the current reality and be up-front about the implications,” the summary said.Though the discussion summaries don’t suggest that participants supported moving many groups down on the priority list, a poll at the end of the dialogue asked participants to make some difficult choices. The dialogue summary said the poll questions were crafted from questions and concerns from the dialogue and public engagement sessions. About 170 people took part in the poll, which also included some who attended public engagement sessions in Henderson County, N.C., and Milwaukee. The poll results are available on the dialogue Web site.For example, when participants were asked if people aged 80 or older should be moved from tier 4 to tier 5, 76% (129) agreed to some extent. And when they were asked if school-age children should be moved up and vaccinated before infants and younger children, 79% (135) agreed.Terry Adirim, MD, MPH, a member of the federal interagency work group that produced the draft vaccine plan, served as a panelist during all of the Web dialogue. Adirim is medical adviser for medical readiness in the Office of Health Affairs in the US Department of Homeland Security. She also helped facilitate some of the public engagement forums.Adirim said the dialogue and public engagement sessions were designed both to solicit public comments and to educate the public about pandemic readiness issues, and the facilitators were impressed with how much many of the attendees already knew about the topics. “We consider it a success,” she said, adding that participants made it clear they had concerns about personal preparedness and government transparency about pandemic and vaccine-related issues.”People also wanted children protected, and moderators familiar with the vaccine plan were able to address why they [the interagency working group] did what they did,” Adirim said.Nicholas Kelley, a masters’ degree candidate in environmental public health at the University of Minnesota, took part in the dialogue during all 3 days. “I’m 24, so I’m in an age-group that would be at high risk, and these issues are fascinating to me,” he said. Kelley is also a research assistant for the CIDRAP Business Source and has worked on college pandemic plans.He said many of the participants were uncertain about how the case-fatality rate during a pandemic will actually steer vaccination strategies, especially since what’s known about the rates during a pandemic is based on historical data. “There’s a lot of disconnect,” Kelley said.”People really want to keep as many alive as possible, but no one really wanted to move people down [the priority list],” he said.Support for protecting critical infrastructure workers grew as the Web dialogue progressed, Kelley noted. “You could see a real shift by the third day. People were adamant about critical infrastructure,” he said.”In a public forum, there are always possibilities for heated emotional exchanges, but the Web format included well-articulated and thought-out comments,” Kelley said of the Web dialogue.In a previous report, the federal interagency working group said that after receiving public comments it would revise the vaccine prioritization plan, which will be considered a final interim report.See also:Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccinehttp://www.flu.gov/individualfamily/vaccination/allocationguidance.pdfOct 24 CIDRAP News story “Pandemic vaccine proposal favors health workers, children”Federal Register notice on comment submissionPandemic vaccine prioritization Web dialogue sitePandemic vaccine allocation poll results
Just months ahead of the 2020 Olympics, the jolt to tourism may presage a broader economic impact from the coronavirus for both Japan and the global economy. Japan could be at particular risk because of its increased reliance on Chinese tourism under Prime Minister Shinzo Abe’s “Abenomics” policies.Nomura Securities had forecast a 240 billion yen (US$2.3 billion) bump from event-related tourism in 2020, which it said would evaporate if the Olympics were cancelled, although organizers have said delaying or moving the games is not an option. Last year, Japan hosted 31.9 million foreign visitors, who spent 4.81 trillion yen.The flu-like virus SARS-CoV-2 has spread to about 80 countries after emerging in central China late last year and has hurt global tourism, air travel and events. About 98,000 people have been infected and 3,300 killed worldwide.Although most cases are in China, more new infections are appearing outside that country. There are no official tourism figures from February yet, but some analysts – and anecdotal evidence from people in the tourism industry – suggest that arrivals from Asia alone are likely to be down by at least half.”You’ve got that negativity that is going to percolate through the system,” said Jesper Koll, a senior adviser at WisdomTree Investments.The hit to economic growth from slowing inbound tourism could be a quarter of a percentage point or more, he said.’Explosive shopping’For Japan, which has seen more than 1,000 confirmed infections, 2020 was supposed to be a record year for foreign arrivals and a boon for an economy already on the brink of recession.About 9.5 million of Japan’s foreign visitors last year were Chinese, a number that has risen more than six-fold over the past seven years.And Chinese visitors spend more than others, accounting for 30% of tourists but 37% of tourist spending last year, according to Japan Tourism Agency data.At a shop near Watanabe’s restaurant, the shelves were lined with rice cookers, sake cups and beauty products such as lipstick usually popular with Chinese tourists, who are known for their “bakugai” or “explosive shopping” sprees.But there were few customers. Shop workers chatted with each other in the nearly empty store.On Wednesday, Bank of Japan Governor Haruhiko Kuroda said the outbreak has hurt consumption through a decline in Chinese tourists.The pain could worsen after Abe on Thursday said the government would suspend existing visas for visitors from China and South Korea and quarantine them for two weeks.Hotels squeezed In the central prefecture of Shizuoka, home to Mt Fuji, Chinese account for as much as 70% of foreign tourists. Some 90,000 people, mostly Chinese, have cancelled hotel and ryokan inn bookings for the first three months of this year, according to the local tourism association.That represents about a third of the total bookings by Chinese tourists during the period.In response, the prefecture has made it easier for tourism-dependent businesses to get loans, said Mitsuhiro Sasamatsu of the local government’s tourism policy division.But some hotels that are dependent on Chinese tourists are temporarily shutting down. “For them, it is better cost-wise to shut down completely than to have the business open for few guests,” Sasamatsu said.About 80,000 new rooms are expected to open in nine major cities between 2019 and 2021, according to a June report from CBRE, a property research firm.Even before the coronavirus, the supply of rooms in all nine was forecast to outstrip demand, according to CBRE.This week, H.I.S. Co, Japan’s largest listed travel agent by revenue, said it expected a full-year loss, rather than a profit, citing the coronavirus impact.Yoshio Adachi, who guides tourists around Yokohama’s bay area in a custom tuk tuk imported from Thailand, reckons the number of Chinese tourists has fallen by as much 60% since the outbreak.He is hoping that a bid to host a casino resort in the city, Japan’s second largest, will pan out and lead to more tourists.”The Olympics will be a one off, so the economy will need to come back after that,” he said. The restaurants at the Exitmelsa shopping centre in Tokyo’s upscale Ginza district are usually packed with Chinese tourists. But on a recent weekday, many lunchtime tables were empty, a sign of the toll that the coronavirus is taking on tourism.For Japanese who have grown dependent on Chinese tourists for business, like waiter Kiyotake Watanabe, it marks a disconcerting trend.”People on group tours would gather together at noon, and 10 or 20 of them would come in all at once,” Watanabe, who works at a Chinese restaurant in the shopping center, told Reuters. Those customers evaporated after China in January banned overseas group tours. Topics :
It added that work would be undertaken to develop infrastructure further as an asset class and increase the amount of financing available to markets.The document also committed G20 members to lowering barriers to investment, boosting the pipeline of projects ready for investment and helping pair up investors and projects.As part of the initiative, the G20 will launch an infrastructure hub based in Sydney to coordinate global governments’ efforts.Against expectations, the G20 also said it supported “strong and effective action” on climate change but did not include any specific wording on cultivating a low-carbon economy.This is despite a report tabled at the G20 finance ministers meeting advising countries on how to factor climate risk into both public and private investment.Australia’s prime minister, Tony Abbott, has previously expressed a desire for the annual meeting to focus solely on job creation measures and resisted attempts by other countries to include the issue of climate change on the agenda.Those in favour of the matter being discussed in Brisbane have pointed to the need for the largest economies to reach a compromise ahead of next year’s climate conference in Paris, which aims to agree new and binding carbon-reduction targets.The Institutional Investor Group on Climate Change (IIGCC), which earlier this year called on governments to create a regulatory environment conducive to low-carbon investments, last week called for the topic of climate change to be part of the G20 agenda in Brisbane.The organisation’s chief executive Stephanie Pfeifer said leaders of the world’s largest economies should seize the momentum building in the wake of the US government’s joint announcement with China to cut carbon emissions and emphasise the importance of a global agreement.“Politicians have said the focus of the G20 is jobs, growth and security,” Pfeifer said. “Tackling climate change by moving to a low-carbon economy provides an opportunity to deliver all three.“Global investors need strong political signals about the direction of travel on climate change in order to invest in low-carbon assets. World leaders should not waste the opportunity to send these signals this weekend.”The OECD will be holding a conference on long-term investment policy in Paris on 26 November The world’s largest economies are to ensure regulation is not preventing pension funds and other institutions from investing in infrastructure under an agreement signed at the G20 summit.The meeting, held on Brisbane, Australia, saw the heads of government agree to implement the OECD’s high-level principles of long-term investment financing, which said public funding should not “crowd out” private long-term capital.In a communiqué announcing the G20 global infrastructure initiative, world leaders said they would look to increase the transparency and functioning of securitisation markets, a goal of the European Commission to attract funding to small and medium-sized enterprises.“These actions will assist in our goal to attract increased private sector financing for infrastructure investment and for small and medium enterprises,” the agreement said.
After a drab first half, substitute Charlie Adam gave Stoke the lead in the 51st minute from Crouch’s knockdown. It was cancelled out 15 minutes later as Libor Kozak pounced on a horrible mistake from Erik Pieters but the Dutchman’s blushes were spared when Crouch restored Stoke’s lead in the 70th minute. Press Association Peter Crouch scored the winner as Stoke secured bragging rights in the Midlands with a 2-1 victory over Aston Villa at the Britannia Stadium. That was the way it stayed as Mark Hughes’ side secured back-to-back home wins in the Barclays Premier League and climbed above Villa into the top half of the table. Visiting boss Paul Lambert chose to leave struggling striker Christian Benteke out of his squad but Stoke were boosted by the presence in their side of captain Ryan Shawcross, who had been very doubtful with a groin problem. Shawcross and his fellow defenders had to be alert as Villa began brightly, creating the first chance 10 minutes in when Ashley Westwood’s cross was headed goalwards by Nathan Baker. Asmir Begovic grasped it at the second attempt, and the Stoke keeper was also behind Aleksander Tonev’s volley from the edge of the box. Marc Albrighton was the first man in the book in the 21st minute, the Villa winger reacting to a push from Pieters with a rash challenge on the full-back. There did not appear to be any real contact but the intent was enough for referee Craig Pawson to show a yellow card. Five minutes later Marc Wilson picked up a booking, although Villa thought it should have been red. The defender’s poor touch just outside the area let in Andreas Weimann, who was then brought down by Wilson. The Stoke player was definitely the last man but Weimann’s touch meant Begovic was a clear favourite to get to the ball first. Stoke had offered little of note in attack but they very nearly took the lead in the 37th minute through Geoff Cameron. The full-back sprinted down the right and sent over a cross that would have dropped into the net but for a fine save from Brad Guzan. The hosts finished the half strongly and with three minutes left Ossama Assaidi jinked his way down the left and sent over a cross that would have been turned in by Crouch but for a superb block by Ciaran Clark. The rebound fell to Marko Arnautovic but he was denied by another block, this time from Baker. Arnautovic was the man to make way as Adam came on for the start of the second half, and it took the playmaker only six minutes to break the deadlock. Clark was shown a yellow card for a crude foul on Jonathan Walters and Cameron’s free-kick was headed on by Crouch to Adam, who took the ball on his chest, turned past Baker and placed his shot beyond Guzan. Referee Pawson was a busy man as tempers flared following a rash challenge from Fabian Delph on Crouch. The midfielder was shown a yellow card, and was slightly fortunate to escape a second booking in a minute when he brought down Adam on the edge of the box, although Chris Herd did talk his way into the book. The equaliser came out of nothing in the 66th minute as Guzan pumped a long ball forward. Stoke looked to have dealt with it but Pieters tried to head the ball back to Begovic and only succeeded in setting up Kozak, who could not miss. But Villa were level for only four minutes before Crouch restored Stoke’s lead. Glenn Whelan found the impressive Cameron down the right, and when Guzan and Herd tried to cut out his cross, the ball fell to Crouch in front of an empty net. There was a suspicion of handball about the striker’s first touch but the Villa complaints were half-hearted. Crouch almost added a third three minutes later with a flick from Pieters’ header that hit a post, while at the other end Kozak’s stinging shot was acrobatically tipped over the bar by Begovic.