US Congress holds hearings on outbreak of influenza A (H1N1)

BMJ 2009; 338 doi: (Published 01 May 2009) Cite this as: BMJ 2009;338:b1837
  1. Bob Roehr
  1. 1Washington

    Questions on the threat posed by the outbreak of influenza A (H1N1) remained unanswered after three days of congressional hearings in Washington, DC. But the meetings dampened down media frenzy through the constant repetition of the limited facts that were known.

    “We are better situated to face the outbreak now than we would have been 10 years ago,” said the representative Henry Waxman, at a 30 April hearing of the energy and commerce committee. That was because of resources and planning devoted to the threat of pandemic flu.

    In calling for additional funding he said, “I hope we can finally learn the lesson that public health work saves both money and lives.”

    The Department of Health and Human Services had already taken steps to combat the virus, such as releasing antiviral drugs (oseltamivir and zanamivir) to state public health agencies. About a quarter of the stockpile of 44 million courses of treatment have been released, said Craig Vanderwagen, assistant secretary for preparedness and response. Local officials will decide how best to use the drugs.

    The polymer chain reaction diagnostic test that differentiates this H1N1 virus from other strains of influenza takes only a few hours to run, the hearings were told. The Centers for Disease Control and Prevention (CDC) had produced and distributed this test to public health laboratories on Monday to avoid the delays that shipping samples from its headquarters in Atlanta, Georgia, would have involved.

    Joshua Sharfstein, acting commissioner of the Food and Drug Administration, said that the CDC and the National Institutes of Health were working to assure that seed stock for vaccine was available in May. Under a best case scenario a commercially produced vaccine supply might become available as early as November, he predicted.

    However, many questions remain unresolved with regard to a vaccine, such as potency, the amount required for a vaccination, whether one or two shots might be required, and whether it might be a stand alone product or combined as one of the elements of a seasonal flu vaccine. Each of those had implications for how much vaccine might become available and how soon.

    Dr Sharfstein said that at least initially the vaccine would be produced through traditional egg based technology because industry and the FDA have more experience with manufacturing, evaluating, and certifying that type of product. He believes that the United States has the capacity in place to produce “more than 160 million doses of trivalent vaccine,” the typical seasonal flu vaccine that protects against three strains of the virus, and “about triple that amount if a monovalent vaccine is used.”

    “We think 600 million doses is achievable within a six month time frame,” said Dr Vanderwagen. He noted that the government had invested $1.3bn (£900m; €1bn) in new cell based culture technology to produce vaccines. Two large new facilities are nearing completion and are likely to begin production in early 2010.


    Cite this as: BMJ 2009;338:b1837

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