Human resources in prioritization strategy during a pandemic

A global impact of a severe influenza pandemic is always the biggest threat for humanity. For instance, the previous huge pandemic event, the flu pandemic in 1918, was associated with over 40-50 million of deaths in three years (around 25 million deaths in the first 25 weeks alone).

   A few centuries earlier, black death in 1346 was responsible for over 200 million deaths until 1353, smallpox since 1520 for over 300 million deaths, and the HIV/AIDS since 1980s counts today over 25-35 million deaths.

   Therefore, vaccination is an important component of a pandemic response (Schwartz & Orenstein, 2009). Public health measures such as reduction of close contacts with others, improved hygiene, and respiratory protection with facemasks or respirators can reduce the risk of exposure and illness but would not reduce susceptibility among the population, and human resources in particular.

   The time required to develop, license, and manufacture pandemic influenza vaccine is an important variable that we must consider for vaccine marketing and prioritization. In 2009, at least 20 weeks required from the time the pandemic virus was identified until the first vaccine doses become available. Today, the process is shorted to a couple of weeks, depending on what kind of vaccine we need to produce.

   For instance, Pfizer-BioNTech needs cut the production time for their vaccine nearly in half, from 110 to just 60 days (8 weeks). Moderna had an mRNA vaccine ready to be tested in people in just over two months as well, while AstraZeneca with Oxford University has more problems to its production lines, thus increasing the time needed to supply countries with vaccines (Weise & Weintraub, 2021).

   In particular, in a highly technical process, the linear strands of DNA are turned into RNA in 40-liter vessels full of enzymes and chemicals over the course of three to four days with a capability of producing up to 10 million doses of vaccine, said a Pfizer official. At that point, the company can produce enough mRNA for 40 million doses per week.

   Hence, bearing in mind on how fast vaccines can be produced, we have to make a clear and fair strategy on who will get vaccines first. Hospitalizations and deaths from pandemic illness can be reduced by directly vaccinating those at highest risk for these severe outcomes, and healthcare workers so that they can continue to provide care to others (Schwartz & Orenstein, 2009).

   Considering the epidemiology and impacts of pandemics, the groups at highest risk for complications and death from influenza, vaccine efficacy, critical societal functions, and ethical issues, advisory committees in United States included healthcare workers, manufacturers of pandemic vaccine and antiviral drugs, and persons at high risk of severe illness and death. Personnel in critical infrastructure sectors other than healthcare were prioritized after these groups.

   To sum up, no guide exists in the context of responding to pandemic events, as a severe pandemic has not occurred for almost a century. Though, Schwartz & Orenstein (2009) conclude that front-line public health emergency responders must get their vaccines first, then medical care practitioners, emergency relief workers, then critical infrastructure such as emergency response services, pandemic vaccine, and antiviral drug manufacturers.

   The next wave of vaccinations starts with national and homeland security (military, national guard, border protection personnel), and finally the general population, with children (all ages), household contacts of vulnerable persons, and individuals with underlying medical conditions that increase their risk of severe or fatal influenza (18–64 years old).

   In any case, we have to evaluate the fact that the more transmissible the virus is, the lower the threshold for switching to nonprioritized vaccination (Lee et al., 2015). Specifically, a decision of switching from a prioritized vaccination strategy to a non-prioritized strategy leads to minimize the overall attack rate and mortality rate. When vaccine supply is limited, such a mixed vaccination strategy is broadly effective (Lee et al.,2021).