I'm not sure which is worse. Pandemic flu preparation which puts most of its eggs (pathogen-free, of course) in the vaccine basket or the one that plans to distribute the non-existent vaccine in a way that it misses the most needy and vulnerable. I guess it's obvious that if the first is bad, the second is very bad so it's worse, but it also a warning that other kinds of preparation may also be seriously flawed from the equity point of view. I know many of you don't care about these folks -- undocumented immigrants, substance users, the homeless, homebound elderly, and minorities. Many Americans think if these "hard to reach" (HTR) populations are at special risk in a pandemic they are getting what's coming to them or at least should get in line behind the rest of us who "play by the rules." I feel the same way about rich people who got rich by cheating the rest of us -- not playing by the rules the rest of us have to play by -- but I daresay this is a minority opinion. In the meantime, the New York Academy of Medicine's Center for Urban Epidemiologic Studies (CUES) has just published a paper in the Academy's Journal of Urban Health that warns even those who don't care much about some of their fellow humans that this could affect them, too:
?Hard-to-reach populations are important to vaccinate not only because they?re personally vulnerable, but because they could be widely transmitting disease to others,? said lead author David Vlahov, PhD, Director of {CUES]. "The importance of achieving high flu immunization rates is magnified by concern over pandemic influenza."[snip]
Most health departments' flu-shot recommendations address how to reach high-risk groups such as the elderly and those with chronic disease, but give less attention to covering HTR populations. Pandemic flu will spread faster if these large segments of the population are left unvaccinated, said Vlahov, who has been working under a $3 million National Institutes of Health grant to devise a plan for quickly finding and immunizing HTR groups. HTR populations in the United States are substantial, including as many as 12 million undocumented immigrants, 1.5 million injection drug users, and 744,000 homeless people, researchers note.
The health of HTR populations has broad implications for the health of the general public, Vlahov said. Some undocumented immigrants, for example, work in poultry processing, the food service industry, and in the home healthcare field, and homeless individuals often ride on subways and buses, coming in contact with large numbers of people. (Eurekalert)
CUES suggests using unconventional sites as venues for vaccination to reach the homeless and other HTR populations. There are those who doubt the efficacy of influenza vaccination (for the record I believe it is effective and have received the vaccine annually) but the underlying public health question relates to the ethical and equity commitment to all members of our society, not just those who know where to go to get vaccinated, have insurance or are considered sufficiently worthwhile by policy makers or members of the general public.
If you think removing the threat of contagious disease from our population is a luxury we can't afford, let me suggest one way we can pay for it: stop the Iraq debacle a couple of days early. A billion dollars can immunize a lot of people. Even the ones that are hard to reach.
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Thats an assumption Revere that even without Iraq, that the money for that would be authorized. Congress has lower numbers even than Bush.....Wonder why?
All well and good in a perfect world Revere, but with only 100 million doses of flu vaccine to be available for this years flu season, who do you immunize first and what about the other 2/3's of our population?
It's not a matter of not caring, but of the best utilization of resources. Our plan during a pandemic is to vaccinate based on CDC guidelines for prioritization. This may be tailored somewhat for local considerations, but the HTR are not in the top 10. If there is enough vaccine for the entire population we will vaccinate based on the most bang for the hands we have available. This would be clinics set up for drive-by, or bus access. We've discussed the HTR populations with a number of agencies that deal with this population and they suggest mobile teams to go out and vaccinate the homeless, immigrants, sheltered, group homes, etc. During a pandemic this would be a time and labor intense effort that, unfortunately, we may not have the staff to accomplish. The HTR are in our plan, but as discussed on many web sites, the response is going to be tailored to the severity of the outbreak.
MRK:"Thats an assumption Revere that even without Iraq, that the money for that would be authorized. Congress has lower numbers even than Bush.....Wonder why?"
For balance:
August 15, 2007
Poll: Majority calls Bush, Congress a 'failure'
WASHINGTON (CNN) The American people seem to be in a bad mood when it comes to evaluating President Bush and the Democratically-controlled Congress, a new CNN/Opinion Research Corporation poll indicates.
According to the poll, 57 percent of Americans deem Bush's presidency a "failure," while 55 percent say the same for the Democratic Congress. Meanwhile, 40 percent call Bush's presidency a success, while only 37 percent give that mark to Congress. (Full poll results [PDF])
Its not all bad news for Democrats. By a 48 to 35 percent margin, Americans say they have more confidence in the Democrats than in Bush to deal with the major issues facing the country today. Confidence in the Democrats has, however, dropped six points since a similar poll in November.
Cruiser, ConnectRN: Yes, it's all about choices and priorities. You write as if the choices are forced on us, that is, they are not choices. But they are. Whether you think they are the best choices or not depends on a lot of things. The CDC priorities are disupted by some, for example, who think vaccinating children is the best way to go. Scenarios that would deny vaccine to the elderly are controversial -- because it's really about choices. And not planning for HTR groups is also about choices. Maybe rational (at least according to some measures of rationality), maybe not (at least according to some measures of rationality). But usually what seems "rational" on the surface has some values very close to the surface we don't examine. So the idea that we should at least plan for the HTR doesn't seem like such a stretch by any measure. IMO.
I disagree Revere. The NPFP states what the policy is and has in case it comes. Its not bounded in law but that plan provides the framework. Its about government liability and thats also the reason that its shifted to the states as "their problem." In all actuality the CDC is not the steward of the public health. The drug companies are. They come up with the criteria for use of drugs and if they can come up with one for vaccinating with shitty vaccine as the cure for panflu, they will. How about vaccinating people who will buy their shitty vaccine to stay alive, not the elderly who wont be around much past a panflu? Hmmm... does this begin to fit for anyone. Only the productive and future productive will be getting whatever vaccine there is.
Immoral? I would do the same thing. The Feds are going to be doing good just to assist the state governments and keep the power grids and infrastructure up. Response initially will be massive and then as it would wade in on us, start limiting down. Trick is to get to the point where its starting to abate, as the support starts to fade.
Hat-You just dont get it. Who cares about the effing polls? They are politicians all and well, there should just be a disease that takes out politicians that comes in after panflu. Everything is in the crapper worldwide and a lot of people would say its because of Bush. I say thats crap... its us and not just in the US. Some some say its crap because we support Bush, some not.
Revere would say its Dems/Republicans etc. and that we always need to do MORE. That more Hat costs money and its like negotiating with whores over price when you are talking about politicians. They take payoffs, they want the new I-35 bridge named after a politician in MSP. Gimme a damn break. Go take a poll a month after panflu comes in with a 30% CFR. They will say government didnt do enough, they didnt provide, they didnt do this they didnt do that. That has happened each and every time something like this has happened.
Here's balance for you. We are a hair more than a year from the elections. Go and vote contrarian and encourage your friends too as well. Whomever is in, vote them out. See if anything changes. I bet not.
There are many people who can't handle the flu vaccine, I am one of them. Will the HTR be looked after to ensure they've been able to handle the shot? No.
there should just be a disease that takes out politicians that comes in after panflu
I second that motion.
Randy,
You and I need to talk (email, chat, whatever.) Email me at beltwaybump@gmail.com.
MRK: If, by declaring that I don't get it, you mean to say that I don't see things the way you do, well, then you are right: I seldom agree with you on the bigger issues, which, for me, include feeling and acting with compassion toward those who never will enter my home or even my country -- you see needless expense, while I see needless suffering.
As for those polls, we agree. Just don't trot them out when it suits you unless you intend to start a stampede.
Then there's the matter of corrupt politicians. Even those who aspire to political office so that they can work toward a better place in which to live, can't hold their breath long enough to keep the corruption (of the game they must play) from settling inside them. The difference is that some come to the job already rotting from within, such as the Bush Gang. If the game can't be changed, then, yes, I'm for changing the gang.
Oh, and, by the way, kudos to you on the specious use of the word Contrarian. Your own, or is that from this month's RNC newsletter?
If there's a politician on this planet that has realized that power corrupts, I'd like to meet them.
If there's a politician on this planet that realizes the tendency to not let that power corrupt them is paramount, I'd like to meet them.
If there's a politician on this planet that has realized compassion coupled with personal responsibility is the way to Be, I'd like to meet them.
Lea: Of course there are decent people elected to public office. This kind of cynicism is just what bad politicians want. That lets them off the hook. But politicians are just people. If you don't like the ones you elected, blame yourself. (unless you don't vote). I'm guessing you don't know many people elected to political office. You only know the ones that make headlines, not exactly a representative sample.
This seems to fit with a Tamiflu modelling paper (sorry cant remember where I saw it) that showed better outcomes in a pandemic - for the richer countries if they did not use all their Tamiflu for their own population but spread some of it around to poorer nations. The general dampening effect on pandemic spread was more effective than having a heavily medicated region in the middle of a rampant pandemic. Sort of spray some water on your house and some on the surrounding brush rather than soak your house and ignore the firestorm.
Then there's resistant staph, already a major issue for the homeless, and for any agency that deals with homeless people, as well as for prisons.
http://www.emsia.org/EMS_Files/Homeless_Disease_Alert.pdf.
This bit of rapid evolution is scary: http://www.cdc.gov/eid/content/13/10/pdfs/07-0503.pdf