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Echo of the pandemic: Experts fear lessons from 2009 H1N1 vaccine ignored

It was a little over a decade ago, and the H1N1 flu virus was raging across the country.

“We invested huge sums in 2009,” said Moore, who is now associate director of the Immunization Action Coalition, a vaccine training organization, describing a whirlwind of spreadsheets and brainstorming that eventually brought together 1,500 pharmacies and hospitals. and clinics in coordinated surgery.

“Then everyone went back to business, as usual, knowing the next pandemic was coming,”

; Moore said. “We knew we would have to restore everything from scratch.”

Now, as the United States prepares for vaccination against the new coronavirus, reinforced by reports of promising results from two major clinical trials, Moore and other experts are disappointed that many of the lessons of the 2009 H1N1 pandemic have not been addressed by current investment. in public health infrastructure to the use of transparent, evidence-based communication strategies. Some of these insights have been ignored, some have been openly ignored, while other mysteries emerge, unsolved, about the impending spread of coronavirus vaccines.

Federal officials are urging state and local health services to listen to the lessons of 2009, although they warn that the upcoming immunization program will be far more complex.

Instead of changing the flu vaccine to attack a new strain, as they did in 2009, the two companies that said their vaccines were more than 90 percent effective this month – pharmaceutical giant Pfizer and biotechnology company Moderna – are inventing new technologies to counter new disease. While H1N1 disproportionately affects people under the age of 65, those most at risk for covid-19, the disease caused by the coronavirus, include the elderly and people with pre-existing conditions whose weakened immune systems usually make vaccines less effective. And next year, people will probably need two doses – three or four weeks apart – of a vaccine that can be delivered in large batches and stored at ultra-cold temperatures.

The most frequently cited lesson from the H1N1 response is common to the current pandemic and may already be hampering the forthcoming spread of coronavirus vaccines: the danger of overly ambitious government communications.

In the fall of 2009, production problems slowed the delivery of the federal pandemic vaccine just as deaths were rising, especially among children. People lined up for life-saving inoculations, but by mid-October, only about a quarter of the amount employees had promised for months was available.

Unsure of when additional deliveries will arrive, public health departments are canceling immunization clinics. People were confused and lost confidence in the government’s strategy. By the time there is enough vaccine, the threat of H1N1 has diminished and many people have lost interest in immunization.

In 2010, at a meeting of vaccine experts, Kathleen Sebelius, then secretary of health and social services, called this highly promising as one of the “learning moments of the pandemic.”

In a recent interview, Sebelius acknowledged the dangers of rising expectations too high, even when she made a sharp distinction between messages to President Barack Obama, whom she described as “absolutely committed to following science and leading science” and “dirty and contradictory” messages. pit science against President Trump’s politics.

The current administration, public health experts say, is referring to a coronavirus vaccine, as if it would quickly end the pandemic instead of taking to heart the lessons of a decade ago and more complex obstacles. Administration officials, such as Health and Humanitarian Minister Alex Hazard, continue to be much more optimistic about the rapid impact of the vaccine than infectious disease experts, who have been closely involved in previous efforts.

“A warning note about how much hope to get vaccinated,” said Thomas Frieden, referring to 2009 when he became director of the Centers for Disease Control and Prevention.

“A lot can go wrong,” said Frieden, now president of Decide to Save Lives, a global initiative aimed at epidemics. “A lot.”

The politicization of public health and the explosion of conspiracy theories exacerbated the threat of misinformation and misinformation that Gigi Gronval, an immunologist and senior scientist at the Johns Hopkins Center for Health Security, helped counter in 2009, both in his professional life and in his and in their personal interactions.

Gronval recalls that his mailbox was filled with messages from acquaintances concerned about the safety of the H1N1 vaccine.

“I keep reading about it and it doesn’t really prove anything [to] I think it’s safe, “a mother wrote about the H1N1 vaccine, wondering whether to take her child for a shot or a nasal spray. “But I also realize that it’s not safe not to get it.”

Gronval responded by providing an article in a newspaper and CDC safety data.

“I would be very wary of many things on the Internet about vaccines, as most of them are full of rubbish,” Gronval explained to his mother.

These old concerns – about the H1N1 vaccine with the same manufacturing process as the seasonal flu vaccine – now see Gronvall as minimal compared to the combination of bloated optimism and outright skepticism accumulated around coronavirus vaccines. The need for frank, fact-based communication is clear in 2009, she said, but now she is concerned that the adverse events that inevitably accompany any innovation “will be manipulated to cause discord.”

A key finding of the H1N1 vaccine was the role that experienced healthcare professionals play in communicating patient safety information.

“The most important people are the ones holding the syringe,” said Bruce Gelin, president of global immunization at the Sabine Vaccine Institute and a former HHS employee. “They will be asked, ‘What do you think?’ “”

With influenza and measles vaccines, there are years of convincing safety data. But health professionals do not yet have the information to answer authoritative questions about coronavirus vaccines that are not being tested in children, for example.

These confidence-building issues can be particularly important when it comes to persuading people in colorful communities to get a new vaccine.

In 2009, African Americans and Latinos were vaccinated at lower rates than other groups, according to a 2012 HHS assessment of the response, which aims to improve preparedness. Just as they have historically been at greater risk of influenza, including H1N1, people of color have been disproportionately affected by the coronavirus. But studies show that a combination of barriers to access, distrust of the medical system and an perceived risk of side effects means they are less likely to be vaccinated.

To counter these trends, minorities are listed among the high-priority groups for the coronavirus vaccine. But even that designation is a complicating factor when it comes to a mass vaccination program, experts say.

“Prioritization is important, but with a huge population, how do you do it effectively?” Gelin said. – If you have a vial and some [of the vaccine] will break down, are you waiting for the right people to show up? “

In 2009, the vaccine was kept in reserve for priority groups, including pregnant women and children, until it became clear that limited supplies were being lost. Some countries have begun to relax their rules for targeting priority groups. In Maryland, Gronvall, who is pregnant and therefore at high risk for H1N1, finds herself in line with others who are not high-priority recipients.

In the case of a two-dose vaccine, which can arrive in large portions and must be stored at extremely low temperatures, it is even more difficult to achieve the prioritization targets. If a person receives one dose and then does not show up for a second shot, he will have wasted a dose that could be used for another recipient. And with numerous vaccines under development, some people in the target groups may decide to wait in the hope that there is a better option in the process.

But perhaps the most resonant lesson to be learned since 2009 – and promises to complicate the forthcoming allocation – is the lack of ongoing investment in public health.

“We need a plan. We’ve had a plan for a long time, “said Jason Turk, a pediatrician and chairman of the Texas Public Health Coalition, who recalled that syringes and other supplies were missing from the H1N1 vaccine.

Some of the logistical challenges in 2009 were met by temporarily extending the 25-year-old federal Vaccines for Children program, which provides free immunizations to minors who do not have insurance coverage. The initiative forms the backbone of national H1N1 distribution plans, and many countries are adapting their infrastructure to register new providers and set up hotlines for health workers who have had problems ordering, receiving or administering vaccines.

Launched in 1994, vaccines for children provide more than 50 percent of children’s vaccines, which are given to states, which then distribute them to more than 40,000 offices of private doctors and public clinics across the country. The program is credited with preventing hospitalizations, saving lives, overcoming the immunization gap between white and colored children, and saving billions in health care costs.

“A system like [Vaccines for Children] expanded to cover adults can bring huge benefits, ”said Turk, providing more flexibility in the event of a new outbreak, while also reducing public health. There are more and more vaccines for adults that protect against shingles, pneumonia, hepatitis and other diseases, many of which are underused.

Moore said the biggest stumbling block in 2009 has yet to be resolved: There is no extensive adult immunization network engaged in federal and state immunization programs, meaning there is no ready-made database to recruit thousands of clinicians who will are required for the administration of coronavirus vaccines.

But she chooses to look ahead, hoping the lessons to be learned from the coronavirus vaccine program will not be wasted.

“I hope we will use this opportunity in a way we did not use 2009,” Moore said. “Occasional investments are not a way to public health.”

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