New pandemic vaccine plan keeps focus on critical workers

first_imgJul 23, 2008 (CIDRAP News) – Federal health officials today released their official guidance on allocating vaccine during an influenza pandemic, with few changes from a previous draft that put military personnel, critical health and emergency workers, pregnant women, and small children at the head of the line.The 25-page guidance document is intended to help state and local leaders allocate scarce vaccine supplies in a pandemic, especially the early stages. The goals are to blunt the effects of a pandemic on public health and the economy and to limit general social disruption.The new document, issued by the Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS), is a revision of one that was released in October 2007. It was developed by a federal interagency working group, which gathered two rounds of input from the public and various stakeholders, including business and community organizations.In a news release, HHS Secretary Mike Leavitt called the guidance “the result of a deliberative democratic process.””This guidance was developed to ensure that our nation’s critical infrastructure remains up and running and we address the needs of all of our citizens, enabling the country to recover from a pandemic more quickly,” added Dr. Jeffrey Runge, DHS assistant for health affairs and chief medical officer.Once a pandemic emerges, “it could be on the order of 20 weeks before matched vaccine begins to flow,” and production capacity will be limited, said Dr. William Raub, Leavitt’s science advisor, at a press conference today. “So we need a plan to target the successive batches as fairly as we can. These guidelines are the instrument to do that.”Consensus on four objectivesFederal officials said all the public and stakeholder input produced a consensus on four objectives for vaccine allocation:Protect people who are critical to the pandemic response and care for those who are sick with the fluProtect providers of essential community servicesProtect those at high risk for infection because of their jobsProtect childrenThe working group settled on five tiers, or vaccination priority groups. To facilitate the assignment of people to the different tiers, the authors sorted the population into four broad categories: homeland and national security, healthcare and community support services, critical infrastructures, and the general population. They also defined several “target groups” on the basis of occupation, type of service, age-group, or risk level.In making their recommendations, federal officials looked at three levels of pandemic severity: severe, moderate, and less severe. Some occupational and risk groups move to a higher or lower tier depending on pandemic severity, but tier 1 is the same for all levels of severity. The following classifications assume a severe pandemic.In tier 1—those first in line for vaccine—are several “critical occupations”: deployed military forces, critical healthcare workers, emergency medical services workers, fire fighters, and police. Also included are pregnant women, infants, and toddlers. Those groups total an estimated 24 million people.Among the health workers assigned to tier 1 are an estimated 300,000 public health personnel, 3.2 million hospital employees, 2.5 million outpatient and home healthcare providers, and 1.6 million workers in long-term care facilities.Tier 2, totaling an estimated 15 million people, includes the following occupational groups: military support, border protection, the National Guard, intelligence services, other national security, community services, utilities (energy and water), communications, “critical government” workers, and two groups not previously included in this tier: pharmacists and mortuary workers. Also included in tier 2 are two high-risk groups: contacts of infants, and children with certain medical conditions.Tier 3 includes several more occupational groups: other active duty military; other healthcare workers; other critical infrastructure sectors, including banking and finance, chemical, food and agriculture, pharmaceutical, postal and shipping, and transportation workers; and other government workers. Also in tier 3 are healthy children ages 3 to 18 years. Tier 3 is estimated to include 64 million people.Tier 4, an estimated 74 million people, consists of two high-risk populations: adults between the ages of 19 and 64 who have chronic medical conditions that increase their risk of severe flu, and everyone age 65 or older.Tier 5 is defined as all other healthy adults between 19 and 64 years old who don’t fall into one of the other tiers, estimated at 123 million people.The guidance says that all groups within a given tier should be vaccinated at the same time, but “sub-prioritization” may be necessary if the vaccine supply is very short, which may be the case through the first wave of a pandemic. The guidance gives recommendations about how to rank groups within tier 1 in this situation, putting front-line inpatient and hospital-based healthcare workers first.Another case of sub-prioritization is in tier 4, which includes 19- to 64-year-old adults with medical conditions and adults 65 and older. If the vaccine supply is limited, the 19- to 64-year-olds should be vaccinated first, HHS advises. The reason: elderly people have a lower immune response to flu vaccines, so putting high-risk younger adults first makes better use of the available vaccine.Protecting essential workersThe main reason for vaccinating workers in critical infrastructure sectors, the report says, is not to reduce general absenteeism, but rather to protect workers whose absence would slow or stop critical functions and also to protect workers at especially high occupational risk.At the press conference, Dr. Ben Schwartz of the Centers for Disease Control and Prevention responded to a question about why transportation workers were not ranked higher than tier 3.”We certainly recognize the importance of including the transportation system,” he said. “It’s in tier 3 because it’s an infrastructure where it’s likely the overall demand won’t increase in a pandemic and may decrease. Transportation workers are not likely to be highly exposed to ill people, and thereby won’t be at high risk. A truck driver is a pretty solitary worker.”Schwartz also said demand for nonessential commodities may drop during a pandemic, which would allow workers to shift to transporting more essential goods.In other observations, the guidance says that general population groups assume greater priority, relative to occupational groups, in less severe pandemics, ie, those ranking 1 or 2 on HHS’s pandemic severity index.During the 1957 and 1968 pandemics, healthcare and essential services were effectively maintained in the United States, the document says. “Because of this, after tier 1, occupational groups in the health care and community support services and critical infrastructure categories are not specifically prioritized and workers in these groups would be vaccinated based on their age and health status as part of the general population.”Experts welcome the planMany public health experts have praised HHS’ hard work on the pandemic vaccine allocation guidance, particularly that of the interagency working group that spearheaded the project. They have also praised the agency for its leadership role.Jeffrey Levi, PhD, executive director of Trust for America’s Health (TFAH), a nonprofit health advocacy group based in Washington, DC, wrote in an e-mail to CIDRAP News today that the guidance represents a step in the right direction. “HHS is to be commended for the breadth of outreach that was part of developing this guidance,” he said.J. Eline Garrett, JD, assistant director for health policy and public health at the Minnesota Center for Health Care Ethics (MCHCE) in Minneapolis, told CIDRAP News that HHS and other agencies have shown strong leadership. “There’s a whole lot that’s good here. A range of pandemic scenarios and scalability are very important, and we value and agree with the way that multiple tracks and category tiers are used to address the practical and ethical complexities,” she said.The public health community also appreciates federal officials’ recognition that there is a need for vaccine allocation, she said.Some see serious gapsHowever, some experts said the federal guidance still contains some serious gaps and raises a host of questions.Levi said there tier 1 includes a large number of people, which demonstrates the need for more vaccine production capacity and the need to more seriously explore vaccine stockpiles.Garrett said that despite the revisions that followed extensive input from stakeholders, the MCHCE still has a number of concerns about the federal guidance. “This is to be expected. This work is difficult and important,” she said.One of the group’s concerns is that the federal guidance doesn’t explicitly and consistently address vaccine efficacy among the different population groups.In some instances, the guidance lacks rationales for the placement of groups on the priority spectrum, which makes it seem less transparent and more difficult for public health officials to grasp, Garrett said. For example, a high priority is placed on vaccinating children, but prioritization decisions might change if the pandemic virus that emerges threatens a different group.Prioritization of workers in homeland security, healthcare, and community support acknowledges exposure levels, but it doesn’t address the risk of death or serious complications, Garrett said. Allocating vaccine to critical workers who are not at risk could shortchange members of the general population who are at risk, she added.Garrett acknowledged that it’s difficult to balance flexibility with uniformity and equity.Federal officials recommend that states uniformly apply the prioritization guidance, but she said a lack of flexibility might be impractical for some areas and in some situations. For example, authorities plan to distribute vaccine in proportion to each state’s population. However, some critical jobs might not be distributed equally among states.Also, some locations might opt to keep schools open during a pandemic and will need to factor teachers into the vaccination scheme, Garrett said.”These questions haven’t been asked or answered, but they should at least be addressed,” she said.Ignoring economic realities?Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, which publishes CIDRAP News, said the current federal guidance falls far short of what’s needed to address critical infrastructure and economic realities.During a pandemic, failure to adequately protect workers in sectors such as power, water, food, transportation, and pharmaceuticals could cause collateral damage that could rival deaths from the virus, he said.For example, Osterholm said the transportation sector is incompletely addressed in the vaccine prioritization plan and that coal workers aren’t listed as a priority, even though half of the electricity in the United States is generated by coal.Also, he pointed out that several lifesaving drugs in the United States are generics that are made offshore. Written stakeholder comments that Osterholm and some of his colleagues submitted to HHS suggested that the federal plan should prioritize some offshore workers who help produce goods, such as generic drugs, that are critical to the United States.See also: Jul 23 HHS news release guidance document on allocating vaccine 12, 2207, CIDRAP News story on public response to draft HHS planOct 24, 2007, CIDRAP News story on draft HHS guidancelast_img read more

Regulatory reform needed to anticipate shift in global trade: Experts

first_imgIndonesia needs to further reform its investment regulations so it can attract more foreign investors amid changes in global trade trends, experts have said.The shift in global trade trend as a result of the COVID-19 pandemic, trade conflicts between the United States and China and growing nationalist sentiments could lead to a rise in investment outflows from major economies such as China to developing countries, they said.Indonesia should further reform its investment regulations so that it can attract foreign companies that would want to further diversify or relocate their investments from China due to the change in global trade trends, said Center for Indonesian Policy Studies’ (CIPS) researcher Andree Surianta. “This pandemic has highlighted Indonesia’s economic vulnerability. Indonesia needs to push its regulatory reform agenda. While the omnibus bill is a good start for reform, we shouldn’t stop there,” he said in an online discussion on Wednesday.The Investment Coordinating Board (BKPM) previously reported that the country’s foreign direct investment (FDI), which accounted for 46.5 percent of total investments, had fallen by 7 percent to Rp 98 trillion (US$6.56 billion) in the January to March period from the fourth quarter of 2019.Andree criticized the government’s reform agenda, which relies on the omnibus bill, saying that the bill did not address the main issue of increasing numbers of ministerial regulations hampering foreign investments.According to CIPS data, the government has issued 15,008 ministerial regulations since the Asian financial crisis of 1997, many of which have hampered investment activities, especially foreign ones. Topics :center_img  “While the omnibus bill revokes 283 articles inside laws and 935 law articles, it is not enough,” he said.The House of Representatives is currently deliberating the omnibus bill on job creation, which will remove a number of regulations seen as hampering investment activities.Besides focusing on regulatory reform, the government is also urged to prepare for a shift in global trade in a post-pandemic world, said HSBC Indonesia president director Sumit Dutta.“In a post COVID-19 world, I think there will be three main trends in the global economic system, which is the push toward automation, economic nationalism and diversification by large companies,” he said.Sumit said Indonesia could capitalize multinational companies’ “China plus one” strategy, where large corporations are looking for a backup plan outside of China to ensure their production continuity once a major crisis such as COVID-19 occurred in the country.“If we look at Indonesia, its macroeconomic indicator is showing a good sign with a high foreign reserve and a stable political system. If we can make changes in Indonesia’s regulation, the country could ramp up its growth in the next three to five years,” he said during the discussion.He also urged the government to ensure the survivability of small and medium enterprises (SME) and control the debt level of state-owned enterprises (SOE) to ensure a solid economic recovery.“I hope the SOEs can manage their debt and all of their obligations because Indonesia’s reputation could be affected if one of the companies goes belly up,” he said.SOE Minister Erick Thohir recently said that Indonesia’s national flag carrier Garuda Indonesia had been severely affected by the pandemic and was struggling to pay its obligations.Garuda Indonesia issued a $496.8 million global sukuk on June 3, 2015, which is due to mature on June 3 with an annual return of 5.95 percent, according to the company’s financial report released in September last year.Another major SOE, steelmaker Krakatau Steel, has been struggling to pay its debts even far before the outbreak hit the economy.In January, Krakatau Steel received approval from its creditors to restructure loans totaling $2 billion by, among other changes, rescheduling repayments to 2027 in order to revive its business.last_img read more

The Latest: Ukraine’s soccer league set to resume Saturday

first_img Share This StoryFacebookTwitteremailPrintLinkedinRedditThe Latest on the effects of the coronavirus outbreak on sports around the world:___The top men’s soccer league in Ukraine will resume Saturday in empty stadiums after a suspension because of the coronavirus pandemic. Associated Press All tennis events sanctioned by the ATP, WTA and International Tennis Federation are on hold at least until late July because of the coronavirus pandemic.But the WTT is not affiliated with those tours and does not need to abide by their decisions about when it is OK to compete. No ATP or WTA ranking points are available for its matches.The WTT says it is increasing its prize money to $5 million. That is $1.5 million more than for its 2019 season.The league is bringing all nine of its teams to one site at The Greenbrier in White Sulphur Springs, West Virginia, because of the pandemic instead of having matches around the United States.___ The Giants echoed those sentiments and said: “With today’s announcement by the governor, we are finalizing our plans to reopen the Quest Diagnostics Training Center. We will continue to have as many employees as possible working remotely. For employees who need to return to work at our facility, we expect to begin that process next week, and we will do so in a systematic and safe way that adheres to the state’s guidelines and NFL protocols.”___Formula One carmaker McLaren says 1,200 jobs will be lost across its entire group’s operations because of the coronavirus outbreak.It was not immediately clear how the cuts would affect the group’s F1 operation. The sport has yet to start its 2020 season amid the pandemic.The McLaren Group says “the cancellation of motorsport events, the suspension of manufacturing and retail activities around the world and reduced demand for technology solutions have all led to a sudden impact” on its revenue-generating activities. The event was scheduled for Aug. 26-29 in Richmond, British Columbia. It is the second competition of the seven-part series that has been canceled, with the Slovakia event the following week also not taking place.“Skate Canada has closely monitored the provincial and federal health authorities position on the COVID-19 pandemic and is committed to the health and safety of the athletes, coaches, officials, volunteers and spectators,” the organization said Tuesday. “Due to the provincial quarantine guidelines for all travelers and social distancing requirements in effect at this time, Skate Canada regretfully made the decision to cancel the event.”No decisions have been made on the other competitions, nor on the senior Grand Prix events.___ The Ukrainian Premier League says it has received approval from the country’s health ministry to restart. No games have been played since March 15.The schedule foresees league games finishing July 19 with a European qualification playoff ending 10 days later.According to UEFA rankings, Ukraine will be the second strongest league in Europe playing, behind only Germany.___The leadoff event to the ISU Junior Grand Prix of Figure Skating has been canceled by Skate Canada because of the coronavirus pandemic. NHL Commissioner Gary Bettman is expected to announce the league’s return to play format this afternoon.Bettman is set to make a televised address at 4:30 p.m. EDT about what hockey will look like if the NHL can resume the season this summer. That means a 24-team straight-to-playoffs format with the league’s other seven teams having their seasons ended.The Players’ Association voted last week to approve the 24-team format proposed by the Return to Play committee. It involves the top four teams in each conference playing a mini-tournament for seeding, while the other 16 face off in best-of-five series to set the field.There is still no timetable for the resumption of game action or when players can return to team facilities for voluntary workouts. This announcement does come on the heels of the league and NHLPA unveiling protocols for those workouts, including a limit of six players on the ice at a time.___ May 26, 2020 The Latest: Ukraine’s soccer league set to resume Saturday Conferences and television networks have agreed to an extension to next week’s deadline for determining the broadcast schedule for college football’s early season games.The Football Bowl Subdivision conferences issued a joint statement Tuesday along with ESPN, CBS Sports, Fox Sports and their affiliated networks. The statement said only that the game times would be set “at a later date as we all continue to prepare for the college football season.” The deadline typically falls on June 1, which is Monday.___ Gov. Phil Murphy tweeted Tuesday that as long as the NFL’s Giants and Jets and the NHL’s Devils follow health and medical protocols, they could open training camps or even hold competition. The NFL’s preseason and training camps wouldn’t begin until midsummer — teams are doing virtual workouts in place of the usual on-field activities because of the coronavirus pandemic. But the NHL is planning ways to complete the 2019-20 season. Should those plans include the Devils, they now can reopen their training facilities.“Professional sports teams in NJ may return to training and even competition — if their leagues choose to move in that direction,” Murphy wrote on Twitter. “We have been in constant discussions with teams about necessary protocols to protect the health and safety of players, coaches, and personnel.”A Jets spokesman said: “We are working closely with Gov. Murphy’s office, the league and our medical staff to establish prudent, health and safety measures for our staff and players. Based on those guidelines, we will begin to open our facility using a phased approach at a time that is the most practical for our operations.” McLaren says the reduced budget-cap level for F1 teams also led to the job losses.The cuts represent about a quarter of the group’s workforce.McLaren executive chairman Paul Walsh says “we plan to emerge as an efficient, sustainable business with a clear course for returning to growth.”___World TeamTennis says it is planning to allow up to 500 spectators at outdoor matches during its three-week season from July 12 to Aug. 2 at a resort in West Virginia. More AP sports: and,Tampa Bay Lightning advance to face Dallas Stars in Stanley Cup finals, beating New York Islanders 2-1 in OT in Game 6last_img read more