ALEXANDRIA, VA -- The top professional society of infectious diseases experts is insisting that all physicians, nurses, and other health workers caring for patients be vaccinated against influenza each year or decline in writing. It is the strongest call yet to plug a critical weakness in the nation's flu preparations.
The Infectious Diseases Society of America (IDSA) is issuing the call to Congress and the Administration as part of a new set of recommendations to better prepare the nation and the world for an inevitable influenza pandemic, as well to improve responses to the perennial threat of seasonal influenza.
The document is one of the most complete assessments to date on the major outstanding issues surrounding flu preparations. IDSA intends its principles to complement Congress' and the Administration's efforts in enacting the Pandemic and All-Hazards Preparedness Act in December 2006. IDSA's principles support many of the concepts found in the new law, but provide additional direction and a level of specificity not found in the Act.
The Centers for Disease Control and Prevention estimates that about 226,000 people are hospitalized with influenza and 36,000 people die from it every year in the United States alone. Even a "mild" influenza pandemic is expected to kill 100,000 to 250,000 Americans, and a severe pandemic could kill 2 million.
Health care workers caring for sick patients are routinely exposed to influenza virus and often spread it around. Yet each year fewer than two in five health care workers get a flu shot.
"It's our professional duty to first do no harm," said Andrew T. Pavia, MD, chair of IDSA's National and Global Public Health Committee. "Voluntary systems haven't brought immunization rates up far enough. For the sake of our patients, all health care workers must get a flu shot every year or they must be required to opt out in writing."
"Responding to the perennial threat of seasonal flu will help us prepare for an influenza pandemic, and vice versa," said Kathleen Maletic Neuzil, MD, chair of IDSA's Pandemic Influenza Task Force. For example, she said, the yearly supply of influenza vaccine fluctuates widely because there are very few pharmaceutical companies interested in manufacturing it. A bigger and more stable market for vaccine would lure more companies into the field, improving the capacity to quickly develop a pandemic vaccine.
IDSA applauds the federal government for making a great deal of progress on pandemic influenza preparedness over the past two years, particularly with the passage last year of the Pandemic and All-Hazards Preparedness Act. But the bulk of the work remains ahead, and Dr. Neuzil noted there is a looming risk of "flu fatigue" as attention drifts elsewhere.
"Attention to pandemic flu is not what it was at this time last year, but pandemic flu is not last year's story," she said. "The threat has always been with us, and it will likely always be with us. If we hope to be ready the next time a killer virus emerges, we need a serious, sustained, long-term commitment."
As part of its own continuing commitment to assist in preparing for this serious threat, IDSA has compiled 12 principles for action on pandemic and seasonal influenza:
- Establish a Pandemic Influenza Vaccine Master Program. An effective vaccine will be the best protection against the next pandemic. The United States needs to lead a large, coordinated, multinational, public-private program on the scale of the Apollo space project. IDSA is calling for an investment of at least $2.8 billion for 2007 alone.
- Boost R&D and stockpiling of antibiotics and antivirals. Public health authorities should have enough medicines to respond to a pandemic on hand ahead of time. New drugs need to be developed. Currently available antivirals are only moderately effective, and resistance to them is emerging.
- Improve diagnostic tools. Influenza shares symptoms with a wide range of other illnesses. Better tools are needed that can distinguish flu from other diseases quickly and affordably, and can be used even in small medical centers with limited resources.
- Improve the financial, legal, and regulatory environment for developing anti-flu products. New funding for drug development authorized under the Pandemic and All-Hazards Preparedness Act will need to be targeted to the right products based on the advice of infectious diseases experts. The pharmaceutical industry will likely need additional incentives such as tax credits for R&D and manufacturing, and enhanced intellectual property rights to entice companies back into the anti-infectives field. The regulatory approvals process needs to be streamlined and standardized among international partners.
- Update plans for distributing and prioritizing anti-flu supplies. During a pandemic, there may not be enough flu-fighting supplies for everyone who is sick or at risk. If so, who should receive them? This question needs to be answered in a transparent and ethical way well before a pandemic hits. (IDSA recently wrote a comment letter to the Secretary of Health and Human Services on this subject. The letter is online at www.idsociety.org.)
- Improve seasonal influenza response. Use seasonal flu to prepare for a pandemic. In addition to mandating vaccination for health care workers, new policies to increase flu vaccination among the public should be adopted. These measures will improve the market for flu vaccine and make it more attractive to industry. Each flu season should also be used to test vaccine distribution plans and procedures.
- Protect Health Care Workers During a Pandemic. Health care workers and other first responders are the community's first line of defense in any public health emergency. Their work also puts them at high risk of illness. They should be prioritized to receive anti-flu drugs and vaccines.
- Build health care systems capable of responding to mass casualty events. National, regional, and local health systems capable of responding to sudden surges of patients are needed. The federal government should develop materials to help train public health and medical personnel, and should also develop guidelines on allocation of scarce resources, liability protection, modified standards of care during an emergency, and other key issues.
- Develop and test "community mitigation" measures: closing schools, sending workers home, isolation and quarantine, and so on. In the absence of enough vaccine or antivirals, these may be the only measures available to protect the public. But how well would they work? And how should they be used? National guidance on these issues needs to be worked out in consultation with experts.
- Improve and coordinate surveillance. A viable, global early warning system is needed to detect an outbreak of pandemic influenza.
- Continue to strengthen leadership, international collaboration, and communication. Continue clarifying lines of authority, holding tabletop exercises, issuing national standards and guidance, and involving experts and stakeholders in discussions and decision-making.
- Commit funding for the long term. Influenza is a yearly hazard. An influenza pandemic could strike at any time. Although recent infusions of funding have been beneficial, a sustained, long-term commitment is needed.
"We've spent the last several decades downplaying the problem of seasonal flu, and ignoring the threat of pandemic flu," Dr. Pavia said. "We're better prepared now than we have been, but we have a very long way to go. We can't take our eye off the ball now."
NEWS RELEASE EMBARGOED UNTIL 12:00 NOON EST ON THURSDAY, JAN. 25
NOTE: TELECONFERENCE THURSDAY, JAN. 25 AT 12 NOON EST CALL-IN INFORMATION BELOW.
A press kit including the full document, "Pandemic and Seasonal Influenza Principles for U.S. Action," is online at www.idsociety.org.
Drs. Pavia and Neuzil will discuss IDSA's principles for action in a teleconference at 12 noon EST on Thursday, Jan.25. To connect, please dial 888-419-5570 and enter pass code: 284-5522. You will be asked to state your name and news organization.
To preregister, call Shelbi Ladd at 312-558-1770 ext. 118 or sladd@pcipr.com.
IDSA is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has 8,300 members, was founded in 1963 and is based in Alexandria, VA. For more information, visit www.idsociety.org.