WASHINGTON, DC—The Department of Health and Human Services Secretary Kathleen Sebelius assured a House Committee last month that the federal government has been gearing up to address H1N1 throughout the fall and winter and that there will be no lack of H1N1 vaccine available. “We will have enough vaccine for everyone. There is enough on order,” said Sebelius.

Since H1N1 cases began appearing earlier this year the government has been working on the development of a suitable H1N1 vaccine. Last month, the administration announced that the US Food and Drug Administration has approved H1N1 vaccines from 5 manufacturers.

At a hearing held by the House Energy and Commerce Committee, Sebelius told lawmakers that distribution of the vaccine is planned to begin in October. Sebelius also assured the committee that HHS is working with states and local communities in its pandemic planning.

The federal government has allocated $1.4 billion for states and hospitals to support planning and preparation efforts. “We are working in close partnership with virtually every part of the federal government, but also with governors, mayors, tribal leaders, state and local health departments, emergency personnel and the medical community and private sector to actively prepare for the virus outbreaks that may develop over the next few months,” she said.

House Energy and Commerce Committee Chairman Rep Henry Waxman (D-Calif) said that the plans the administration developed several years ago to prepare the country for a pandemic “appear to be unfolding appropriately.”

Administering the Vaccine

Sebelius told lawmakers that one of the federal government’s main concerns is making sure that groups identified by Centers for Disease Control and Prevention who are at high risk get the vaccine. These groups include pregnant women, people between the age of 6 months and 24, caregivers of infants, health care workers, and people between the ages of 25 to 64 who are at higher risk for the virus because of chronic health disorders. The virus is especially dangerous to pregnant women. “What we saw in the spring is that pregnant women constituted about 1% of the population. They were 6% of the hospitalizations and deaths that occurred,” said Sebelius.

Sebelius added that these affected pregnant women had no underlying conditions other than the pregnancy. While pregnant women may be reluctant to take any additional medications or vaccines, the risk of an adverse event due to the vaccine “is outweighed by the risks that occurred without being vaccinated,” she said.

Hospitals and Providers Prepare

Lawmakers questioned whether hospitals are prepared to deal with a large influx of H1N1 patients. “With regards to the nation’s hospitals, do we have the surge capacity to meet this potential of demand?” said Rep Frank Pallone (D, NJ).

Part of the pandemic planning effort launched by the federal government several years ago was to build a surge capacity for hospitals, according to Sebelius. She added that “billions of dollars have been invested over the last number of years,” in this effort.

Sebelius said that HHS does have systems to put in place if additional medical capacity is needed, such as its Medical Reserve Corps. The MRC is comprised of organized medical and public health professionals who serve as volunteers to respond to natural disasters and emergencies.

Sebelius said, however, that it is not necessary for everyone who thinks they have H1N1 to show up at a hospital emergency

room, and that people should take the kind of steps that they would take with regular seasonal flu, such as contacting their health care provider. “We are concerned that we also try to get information to the public as rapidly and as clearly as possible. The worst of all worlds is to have everybody show up at the hospital. The vast majority of individuals who get H1N1, so far, are not terribly ill and do not require additional treatment,” she said.

Lawmakers also wanted to know whether health care workers will need additional protection from H1N1. “Are you and your folks confident that in these environments where all of us who are sick are going to rush that there is adequate masks and protective equipment so that those we rely on will be healthy in the process?” asked Oregon Republican Rep Greg Walden.

Sebelius said that scientists are not in complete agreement about the protocol for N95 respirators, but that discussions on this topic are ongoing. “The Institute of Medicine did a rapid response study and they came back with a protocol, which I would suggest is the ideal case scenario—a respirator per provider for every patient seen,” she said.

Sebelius said that there is not “adequate supplies” to follow that protocol, and that officials are working with OSHA and CDC to develop a protocol that is “more in fitting” with the supplies that exist “We have to look at what is available, so that discussion is actively underway,” said Sebelius.

A step that all health workers can take to protect themselves from H1N1 is to get a vaccination once it is available. Sebelius said that it is “most alarming” that many health care workers typically do not get vaccinated for the seasonal flu. “Less than 50% of health care workers ever get vaccinated for seasonal flu. Even though they are a priority group for H1N1, we are afraid that rate may be the same. So I would say that is step 1,” she said.

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