Lack of priority setting in pandemic-influenza plans worldwide.

One-third of countries engaged in pandemic-influenza planning have not prioritized who should get vaccinations and antiviral medications, according to researchers from the Johns Hopkins Bloomberg School of Public Health and the Ben-Gurion University of the Negev, in Israel. In the largest pandemic-plan review to date, the researchers looked at 45 national pandemic-influenza plans from developed and developing countries. Results from the study are published in the October 2006 issue of the journal PLoS Medicine under the title "Priority Setting for Pandemic Influenza: An Analysis of National Preparedness Plans."

"Because of costs and the time delay of manufacturing strain-specific vaccines, critical medical resources are likely to be scarce in a pandemic and will require rationing," said Lori Uscher-Pines, lead author of the study and a doctoral candidate in the Bloomberg School of Public Health's Department of Health Policy and Management. "We discovered, however, that individual countries have not consistently prioritized population groups for vaccines and antivirals. No countries prioritized population groups to receive ventilators, face masks, and other critical resources."

The study targeted 45 national pandemic influenza plans--19 from developed and 26 from developing nations. In total, the plans would affect 3.8 billion individuals, or two-thirds of the world population. The study found that 28 countries prioritized individual population groups that are to receive vaccines in a pandemic; 22 countries prioritized groups that are to receive antiviral medications.

The failure of many countries to prioritize recipients for antivirals is an unexpected finding since antivirals may be the first--and perhaps the only--pharmaceutical intervention available to many countries in a pandemic.

In the 28 nations that prioritized recipients for medical resources, health care workers were most frequently ranked at the top of vaccine and antiviral priority lists. After that, countries differed greatly on who should receive top priority--high-risk individuals, such as the elderly and children, or essential-service workers, such as communications/telecommunications workers, firefighters, key government decision makers, and energy/power supply workers.

The authors also learned that some countries have made children a top priority, even though epidemiology provides only mixed support for this practice and the World Health Organization has recommended against it. None of these countries cited sociocultural values in reference to this decision.

"Prioritization can play a significant role in international preparedness against pandemic influenza," said senior co-author Ran D. Balicer, M.D., M.P.H., of the Ben-Gurion University. "In the absence of explicit WHO guidelines, nations should be encouraged and supported in priority setting based on individualized pandemic-impact estimates, and should be guided in balancing evidence and ethical considerations."

Other co-authors were Lori Uscher-Pines, Saad B. Omer, Daniel J. Barnett, and Thomas A. Burke. The study "Priority Setting for Pandemic Influenza: An Analysis of National Preparedness Plans" was supported through a cooperative agreement with CDC.