Monday, November 16, 2009

H1N1 watch: Monday

The decision to go with an adjuvanted vaccine is a choice that keeps causing problems: "Hundreds of flu vaccine doses thrown out."
Most flu vaccines can last up to a month after being injected, but Arepanrix, the H1N1 vaccine, is more difficult to manage. The vaccine is delivered as two components, known as antigen and adjuvant, which are mixed on-site, then injected. Each dose contains enough for 10 patients and must be used within 24 hours after being mixed.
This mixing is causing waste, multiple times over all over the country. The short shelf-life is a factor. Note, there are no such problems with the unadjuvanted vaccine, the use of which we are now seeing expanded:
Because the adjuvant is what gives the vaccine such a short shelf life, the unadjuvanted vaccine, for pregnant women, does not have the same expiry timeline.
Tell us again why we just didn't go with that one in the first place?

If you need a refresher on the litany of H1N1 issues that have led to delay, the Globe provides a handy catalogue on that front too. Italicized are those decisions that have proven problematic and could have been changed by the federal government:
Losing doses is just one hiccup in a rollout of the H1N1 vaccine that has been fraught with problems from the beginning. First, the H1N1 virus proved difficult to grow in eggs, meaning it took more time to harvest antigen. As well, a decision was made to finish manufacturing seasonal flu vaccine before moving on to the production of H1N1 vaccine, which delayed it by about two weeks. [Blog ed. note: some say this choice delayed the H1N1 vaccine by 6 weeks, not two.]

The fact that Canada's vaccine was produced in a single plant also meant that getting vaccine into vials took more time.

Then came the decision to produce unadjuvanted vaccine for pregnant women, which meant that production of adjuvanted vaccine was shut down briefly.

Time was also not on officials' side: With H1N1, flu season arrived early and that meant provinces and territories were not quite ready to vaccinate when the second wave of the flu arrived. The chronic shortage of nurses meant that there were limits on how many vaccines could be administered.

When vaccines were first made available, public-health officials published priority lists for vaccination but made the mistake of saying no one would be turned away, which create huge line-ups and long waits.
I am highlighting the "chronic shortage of nurses" because the federal government has chosen not to provide funding for the front line distribution of the vaccines, despite the obvious logistical problems and need.

Until next time...