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Optimizing Influenza Vaccine Distribution

Science  25 Sep 2009:
Vol. 325, Issue 5948, pp. 1705-1708
DOI: 10.1126/science.1175570

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Rethinking Vaccine Distribution

The distribution of vaccines is a complex issue lying at the intersection of public health, economics, and ethics and it cannot be decided in hindsight as an epidemic unfolds. Thus, mathematical modeling can be valuable for guiding policy, and Medlock and Galvani (p. 1705, published online 20 August) present an analysis of how to distribute influenza vaccine among different age groups in a way that will minimize transmission. Scenarios were developed for different outcomes that tell us what happens, in terms of numbers of infections, mortality, and cost, when various cohorts are targeted for vaccination under different epidemic conditions, and compare 1918- and 1957-like epidemics. The scenarios could apply equally well to antiviral drug distribution. The conclusion is that the current recommendations for vaccine distribution from the U.S. Centers for Disease Control and Prevention may need to be revised to include age-related patterns of transmission to minimize the impact of epidemic influenza.

Abstract

The criteria to assess public health policies are fundamental to policy optimization. Using a model parametrized with survey-based contact data and mortality data from influenza pandemics, we determined optimal vaccine allocation for five outcome measures: deaths, infections, years of life lost, contingent valuation, and economic costs. We find that optimal vaccination is achieved by prioritization of schoolchildren and adults aged 30 to 39 years. Schoolchildren are most responsible for transmission, and their parents serve as bridges to the rest of the population. Our results indicate that consideration of age-specific transmission dynamics is paramount to the optimal allocation of influenza vaccines. We also found that previous and new recommendations from the U.S. Centers for Disease Control and Prevention both for the novel swine-origin influenza and, particularly, for seasonal influenza, are suboptimal for all outcome measures.

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