Public weighs in on pandemic vaccine allocation plan

first_imgDec 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personnel and children as top priorities.During the Web dialogue, participants offered several ideas for revising the draft guidance, according to daily summaries on the dialogue Web site.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 “It was noted that the draft guidance is not age-based, but leans more toward protecting society (critical infrastructure) and the population groups at the top [of the priority lists],” the summary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 resultslast_img read more

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Use antigen tests for screening but with caution: Experts

first_imgPCR tests can take hours or even days to process in labs as testing backlogs remain common in the country.”Certainly, antigen tests can be used in Indonesia as recommended by the WHO in order to replace rapid antibody tests, and screening with [antigen] tests can be more effective and won’t be a burden on PCR tests as the gold standard in diagnostic tests,” he said.Antigen tests use nasal or throat swab samples to detect certain proteins on the surface of the coronavirus. These tests do not require advanced lab equipment and come in the form of paper strips resembling home pregnancy tests.Antibody tests detect antibodies in blood samples – which may only develop weeks after infection and can form differently in people with certain conditions. Amid persistent COVID-19 testing constraints, the government appears to be looking into using rapid antigen tests, which are cheaper and faster although less accurate than the gold-standard polymerase chain reaction (PCR) tests. Experts are on board but urge caution.National COVID-19 task force spokesperson Wiku Adisasmito said the government was searching for better and more accurate alternatives to its current screening method of rapid antibody tests, whose inaccuracy experts have highlighted, and that it was considering antigen tests.Wiku said on Tuesday that the government was aware of the World Health Organization’s recommended list of rapid antigen test kits, which could provide results in less than 30 minutes. PCR tests detect the virus’ RNA, making them more accurate than the other two tests, but they require specific laboratory safety measures, skilled workers and specific machines.An insufficient number and uneven distribution of facilities that meet these requirements have been cited as reasons behind Indonesia’s low testing rates compared to other countries. Long testing turnaround remains a problem, affecting containment efforts that require people to be tested, traced and isolated quickly.Read also: COVID-19 leaves lab workers grappling with unprecedented testing scalePCR tests that are not subsidized by the government can cost more than Rp 2.5 million (US$168) – prohibitively expensive for many Indonesians. Some 120 million antigen tests costing $5 each will be made available to poorer nations, the WHO announced on Monday.The WHO said earlier that the use of rapid antigen tests could be considered in areas experiencing widespread community transmission, where it might not be possible to administer PCR tests or where test results faced long delays.But experts have said that further confirmation by PCR tests is necessary, especially if someone tests negative but shows symptoms indicative of COVID-19.Studies of antigen test kits of various brands cited by the WHO have shown that their sensitivity ranges between 0 and 94 percent, meaning the chance of false negatives could be high. But their specificity is consistently above 97 percent, meaning the chance of false positives is low.“I agree [about the use of antigen tests] for early phases, during which the viral load is believed to be at the highest level,” said Aryati, a professor of clinical pathology at Airlangga University who also chairs Indonesia’s Clinical Pathology and Laboratory Medicine Specialists (PDS PatKLIn) association. “It can be performed both on people with symptoms or without.”Unlike PCR tests, which can detect even fragments of the virus, causing some people to test positive for months after symptoms disappear, antigen tests are believed to best detect the virus in patients with high viral loads. This means up to three days before symptom onset and within the first five to seven days of illness, according to existing, though limited, studies cited by the WHO.Read also: Carry out proper mass testing with PCR, experts sayBut since studies of the virus’ infectiousness over time are limited and require a more sophisticated viral culture, rather than simply relying on predicted viral loads, University of Indonesia microbiologist Anis Karuniawati said it was important to cautiously determine which populations were suitable for antigen tests. She said health authorities should consider what steps would be taken after results came back.”Whether we want it or not, we need a method that allows us to detect [possible cases] even more widely,” Anis said.She said these tests could be used not only where testing was scarce but where quick results were necessary, such as for triage purposes at hospitals. These tests could be performed outside labs, although the transmission risk during the processing of the tests had to be studied first, she said, adding that tests should be performed and interpreted by experts.The PDS PatKLIn has suggested that trained workers with personal protective equipment (PPE) perform the tests and that the samples only be processed at labs with level 2 biological safety cabinets and sufficient cold chain and infectious waste bins.It was important to purchase the tests advised by the WHO, experts said, and those that were not on the list should be validated by Health Ministry labs or other labs planning to use them to ensure their quality – unlike what occurred with the existing and widespread rapid antibody test kits.The WHO has recommended a minimum threshold of 80 percent sensitivity and 97 percent specificity for antigen test kits.”Don’t use just any [brand of test]. Use what’s recommended by the WHO […] There must be quality control and assurance. Don’t jump into using them without the knowledge of clinical pathologists,” said Herawati Supolo Sudoyo from the Eijkman Institute of Molecular Biology.Topics :last_img read more

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