Swine flu and the limited role of vaccines in initial outbreak response

The unfolding swine flu outbreak has raised considerable interest in the potential development of a vaccine against the virus. A story in yesterday's New York Times reminded us that a "Swine Flu Vaccine May Be Months Away, Experts Say," something that has long been known among public health officials considering the role of vaccines in response to a pandemic.

(This is the reason for the funding, development, and stockpiling of 'pre-pandemic' avian flu vaccines to bridge this gap for the H5N1 virus that had long been the focus of pandemic planning. Swine flu (H1N1) appeared too quickly for this to be an option for the current outbreak.)

Forbes has a similar story, and the Chicago Tribune, MSNBC, Time, and nearly every other media outlet has explored the challenges and timetable for swine flu vaccine development.

Here are the swine flu websites from CDC and WHO, which announced today it would now refer to the virus and disease as 'influenza A (H1N1)" rather than swine flu.

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There would no doubt be many issues to be discussed on this site and elsewhere if federal officials determine that a swine flu vaccine is needed, including significant questions regarding the ethics of development, production, safety testing, financing, and distribution.

In the meantime, however, vaccines are not relevant to the immediate public health challenges facing American and international health officials, even though they and antiviral drugs have dominated public discussions of pandemic preparedness over the past few years. In a piece for Science Progress titled, "When Drugs Aren't the Answer," we write:

"The limited value of pharmaceuticals and vaccines in the early stages of a potential influenza pandemic is well known to public health officials and diligent readers of the vast planning documents issued by the federal government since 2005. Instead, the severity of swine flu or any potential pandemic will be determined in large part by how quickly those infected or exposed are identified, located, and separated from the healthy. This is the decidedly low-tech but life-saving work upon which many of the achievements of public health in the past century have been based."

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"Government officials who are already justifiably concerned about creating unnecessary panic may be forced to introduce targeted social distancing, isolation, and quarantine programs to a public that has heard too little about their tremendous importance and too much about vaccines and antivirals that are barely relevant to the immediate health challenges at hand. Through the efforts of the public health community coupled with a bit of luck, swine flu may dissipate without becoming a full-blown pandemic, giving health policy-makers a second chance to revisit these critical aspects of a comprehensive, just approach to pandemic preparedness."