Abstract
This commentary evaluates Canadian actions following identification of pH1N1 influenza virus in 2009. We also report on some international issues affecting vaccine manufacture, and compare pH1N1 influenza vaccination programs in several industrialized countries.
WHO’s pandemic declaration was the trigger for Canada to take the following steps: 1) implement its sole source pandemic vaccine supply contract, 2) use an alternate, internationally-developed approach to authorize emergency use of adjuvant-containing vaccine not yet fully approved in Canada, 3) release stocks of antiviral, and 4) develop many health-related policies, through committees other than those normally used outside a pandemic. We note key successes and challenges in these steps, and suggest responses to two priority issues: first, improve planning for surges in demand for the clinical services that represent the main way in which severe disease impact was reduced, and second, establish from the outset of Public Health planning that immunization programs will phase use of vaccine in different target groups, as done elsewhere, reflecting realistic vaccine delivery rates and the likely early occurrence of the main epidemic wave.
Key words: Influenza pandemic, vaccines, health care delivery, disaster planning, antivirals, rural health
Résumé
Ce commentaire évalue la réponse canadienne lors de l’apparition de la grippe pandémique H1N1 en 2009. On y trouve un compte rendu de quelques enjeux internationaux ayant influencé la fabrication du vaccin ainsi qu’une comparaison des programmes de vaccination contre la grippe pandémique H1N1 dans plusieurs pays industrialisés.
Au Canada, la déclaration de l’Organisation mondiale de la santé (OMS) confirmant une pandémie a été l’élément déclencheur pour amorcer les mesures suivantes: 1) Mettre en œuvre le contrat à fournisseur unique pour l’approvisionnement du vaccin pandémique; 2) Utiliser une approche de rechange, élaborée à l’international, pour autoriser l’utilisation urgente d’un vaccin avec adjuvant qui n’était pas encore complètement homologué au Canada; 3) Rendre disponible les médicaments antiviraux; et 4) Faire élaborer de nombreuses politiques en matière de santé par des comités différents de ceux habituellement utilisés lorsqu’il n’y a pas de pandémie.
Les auteurs décrivent les principaux succès et obstacles liés à ces mesures, et proposent des réponses à deux enjeux prioritaires: 1) Améliorer la planification des poussées soudaines de la demande de services cliniques, qui ont été la principale mesure permettant de diminuer les répercussions graves de la maladie; et 2) Décider, dès le début de la planification en santé publique, que les programmes de vaccination feront une utilisation échelonnée du vaccin pour différents groupes désignés. Cette mesure, utilisée ailleurs, tient compte des débits réalistes d’administration des vaccins et de la probabilité d’une apparition précoce de la principale vague épidémique.
Mots clés: pandémie d’influenza, vaccins, prestation des soins de santé, plan catastrophe, antiviraux, santé en zone rurale
Footnotes
Disclaimer: Alan Kendal was the Special Advisor for Influenza to the Principal Health Officer, BC, Canada, during 2009. Opinions expressed here are not to be considered those of the Government of British Columbia.
Conflict of Interest: None to declare.
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