Presidential and HHS advisors on H1N1 mortality scenarios and vaccine plans

Observers of American vaccine policy (and readers of this site) are well aware of the veritable alphabet soup of government offices and advisory bodies with responsibilities for aspects of vaccination in the U.S., including ACIP, NCIRD, VRBPAC, CBER, NVAC, NVPO, NVICP, NIAID, and their parent agencies, CDC, FDA, and NIH, all part of HHS. Despite the potential for overlapping jurisdiction and regulatory gridlock, each of these groups has a clearly defined set of duties and, in normal circumstances, outward appearances suggest a relatively well-functioning bureaucracy.

The situation surrounding H1N1 (aka swine) influenza has meant even more executive branch interest in planning a possible vaccination program, most notably within DHS (Department of Homeland Security) and ED (Department of Education).

Lately, rarely a day passes without an executive branch department, agency, or committee offering a new report on some aspect of the planning efforts. Yesterday, PCAST became the latest addition to the H1N1 'initialese' lexicon, as the President's Council of Advisors on Science and Technology (part of OSTP in the EOP, for those keeping score), issued an 86-page report to the president on H1N1 preparations.

The report, discussed today by the Washington Post, the Associated Press, and the New York Daily News, among others, has generated most attention for its estimates of potentially 90,000 deaths and 1.8 million hospitalizations caused by H1N1 influenza in a 'plausible scenario,' according to the council. Among its recommendations were to accelerate availability of vaccine, increase communication efforts and disease surveillance capabilities, and appoint a point-person in the White House to coordinate planning and response. The White House released a document accompanying the report that details progress made toward these recommendations.

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Also yesterday, the previously mentioned NVAC (National Vaccine Advisory Committee) met via teleconference to discuss H1N1 preparations. The meeting, covered only by the indispensable CIDRAP News, focused on communication strategies surrounding vaccine safety concerns (real or alleged) all but certain to emerge once vaccination begins. According to Robert Roos' story, the committee approved a recommendation stating that HHS:

..."develop, and where possible test in advance, a strong and organized response to scientific and pubic concerns about vaccine safety that may emerge during the 2009 H1N1 vaccination campaign."

"The challenge will be to communicate effectively and to differentiate rapidly between adverse events that may be causally related to the vaccine and those which would be expected by chance alone," states the recommendation.

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The takeaway from the latest round of reports, meetings, and recommendations? Both groups in the news yesterday seem to be correct in emphasizing the critical importance of coordination within the federal government (not to mention among state and local governments) and communication to the general public. With so many government hands involved in H1N1 planning and response, many of them unfamiliar with public health and vaccination, the risk of conflicting and confusing policy and public guidance is real.

In addition to the PCAST-proposed White House "Flu Czar" (as some have dubbed it) to coordinate policy-making, identifying a single individual to serve as the public face and voice of the federal government on H1N1 influenza this fall seems essential. During the virus' first wave this spring, then-acting CDC director Richard Besser served in this role to overwhelmingly positive reviews. (Dr. Besser is soon leaving CDC for a television position at ABC News.) Such an individual will be vital to translating reports and recommendations from the aforementioned alphabet soup of government bodies into a single, coherent set of messages for the American public.