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Who should be first in line for vaccine in the event of a flu pandemic?

The federal government released yesterday a draft of its guidance for how health authorities should allocate scarce doses of influenza vaccine during a pandemic. The working group behind the plan sorted the population into categories and then ranked groups in order of priority inside each category. Details after the jump.

From the pandemicflu.gov site, here's the draft list:

Homeland & National Security

A

* Deployed and mission critical personnel

B

* Essential support and sustainment personnel
* Intelligence services
* Border protection personnel
* National Guard personnel (who are not already included in Level A)
* Other domestic national security personnel

C

* Remaining active duty military and essential support personnel

Health Care & Community Support Services

A

* Public health personnel
* Inpatient health care providers
* Outpatient and home health care providers
* Health care providers in long-term care facilities (LTCFs)

B

* Community support services and emergency management personnel

C

* Other important health care personnel

Critical Infrastructure

A

* Emergency Medical Services personnel
* Law enforcement personnel
* Fire services personnel
* Manufacturers of pandemic vaccine, antiviral drugs, and other key pandemic response materials
* Key government leaders

B

* Energy sector personnel (electricity and natural gas)
* Communications personnel (telephony and IT)
* Water sector personnel (potable and waste water)
* Government personnel

C

* Transportation sector personnel
* Food and agriculture sector personnel
* Banking and finance sector personnel
* Pharmaceutical sector personnel
* Chemical sector personnel
* Oil sector personnel
* Postal and shipping sector personnel
* Other important government personnel

General Population

A

* Pregnant women
* Infants and toddlers, 6 – 35 months old

B

* Household contacts of infants under 6 months old
* Children 3 – 18 years old with high-risk medical conditions
* Children 3 – 18 years old without high-risk medical conditions

C

* High risk persons 19 – 64 years old
* Persons 65 years and older

D

* Healthy adults, 19 – 64 years old, not included in other categories

The page for the draft guidance has much more detail, including a discussion of ethical considerations:

Underlying the working group’s deliberations was a strong consideration of the ethical issues involved in allocating vaccine when supply is limited. An ethicist from the National Institutes of Health who participated as a member of the working group and academic ethicists discussed ethical frameworks and their application to decision making on vaccine allocation. Vaccinating some people earlier than others to minimize health and societal impacts of a pandemic was considered ethically appropriate. Other important principles that were considered were: fairness and equity (recognizing that all persons have equal value, and providing equal opportunity for vaccination among all persons in a priority group); reciprocity, defined as protecting persons who assume increased risk of becoming infected because of their jobs; and flexibility to assure that vaccine priorities are optimally tailored to the severity of the pandemic and the groups at greatest risk of severe infection and death.

A second ethical focus was the importance of developing guidance through an open and transparent process with multiple opportunities and avenues for input from the public and stakeholders. Public engagement meetings were held in Las Cruces, New Mexico, and Long Island, New York, and included a diverse group of participants. In addition, stakeholders participated at a meeting in Washington D.C. that included representatives from private sector businesses and community organizations. The working group is committed to maintaining an ethical process as comments on the draft guidance are sought through a variety of forums and media.

The public comment period for the plan starts October 26.