Life is unfair. Or, at least, it sure can look that way.  The New York Times ran a great article over the weekend really demonstrating how folks really don’t understand the “rationing” of H1N1 vaccine nor how its made.  For example, consider this: Who of these four persons is first in line for the H1N1 vaccine?

  1. A great-grandmother in a nursing home with lung problems?
  2. A hospital cafeteria worker being treated for AIDS?
  3. An overweight department-store Santa with a line of children waiting for his lap?
  4. A healthy Wall Street banker whose trophy wife is pushing a new baby in a $600 Bumbleride jogging stroller?

The answer is likely to make you cringe but it is the banker. !@#$%^&*()_+!@#$%^&*….You say!

Well let’s explain, in normal seasonal flu, old folks get the vaccine first if there is a shortage, as seasonal flu is a killer for older people. In the current H1N1 pandemic, it’s totally different. It’s pregnant women and children first, and in the rush for the lifeboats, elbows are beginning to fly.

As health professionals had thought, the public is confused. Older people are still first in line for seasonal flu shots, but all the media attention has been on swine flu. Both kinds of shots are in short supply. More H1N1 vaccine is being made albeit slowly. All the seasonal vaccine has already been made — but middle-aged people who didn’t know one shot from another and bared their arms for any available needle took much of it.

Now that the health authorities are cracking down on the H1N1 vaccine and real triage has begun, some older Americans are finding the new realities pretty harsh. Breathing problems and heart conditions are common among people over 50, and some have been calling their Congressmen to complain. Those older Americans and their advocates point to studies indicating that elderly people rarely catch swine flu but, when they do, their outcomes are just as grim as they are for seasonal flu, which kills 36,000 mostly elderly people a year.

OK, so back to the banker? Why him?  He gets the shot not for his sake — many Americans would be pleased to see him boil in oil — but to save his baby. Infants under six months old are at very high risk but too young for a flu vaccination. The hospital employee does not have direct patient contact; if he is taking his anti-AIDS drugs, his immune system is not suppressed. And even if Santa is morbidly obese — though that could create a lap problem — he is presumably over 18.

And the great-grandmother? Her age is actually helping her out in this case!  She was born before 1957, probably caught H1N1 flus several times growing up, and may still have protective antibodies. True, if she is unlucky enough to catch swine flu anyway, she is at risk. But public health is a numbers game and her probability is low. Also, flu shots don’t protect the aged well, since their immune systems may be too weak to build new antibodies. Studies suggest it is more effective to inoculate their nurses and visitors.

The ground for all these decisions was laid on July 29, when the C.D.C. released guidelines saying which Americans should be first in line. The first swipe at the problem comprised 159 million Americans — half the population. It included everyone under 25, all health care workers and everyone of any age with heart or lung problems, diabetes, obesityor a list of other ills.

Now, just as the pandemic’s fall wave has peaked, there are only 42 million doses of swine flu vaccine to go around — by coincidence, the same number that the C.D.C. said were at top risk and should be the first of the first should there be a shortage of the vaccine. They are pregnant women, people caring for infants less than six months old, health care workers with direct patient contact, children six months through 4 years old and children 5 through 18 with chronic medical problems.

Who was left out in the narrower reslicing of the cake? Everyone over age 18, unless they are pregnant, have an infant at home or treat patients.  That means that about 117 million Americans have been told: Yes, you are officially at risk. Please step to the rear anyway until more of this slow-growing vaccine is ready.

Some understand; many are upset. They want their shot, or they want someone’s head to roll. Politicians are responding to their anger, dragging health officials before Congress to explain their priorities.

Who is to blame?  Technically you could say all of us for poorly funding public health for many years.  The thing to remember is flu vaccine has been made the same way for the past 50+ years.  Very little effort has gone into bringing this old-egg based methodology into the modern era.  It was the threat of the H5N1 flu (bird flu) that caused monies to be begin to be spent into developing cellular based technology for vaccine production.  HOWEVER, that is still years off unless something dramatically changes in the near future (like more money for research funding).  Public Health has been long ignored in this country and what we are dealing with now is the direct result of that lack of attention and funding for many years.

http://www.nytimes.com/2009/11/22/weekinreview/22mcneil.html?scp=1&sq=back%20of%20the%20line&st=cse