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    Swine Flu Vaccine: The Race Is On

    Massive Vaccine Effort Takes Shape as Swine Flu Pandemic Sweeps Globe

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    Moreover, flu viruses are tricky -- and so is the making of a flu vaccine. Lots of snags can slow production. And swine flu could become more severe, making it ethically imperative for the U.S. to use adjuvant to stretch vaccine supplies so they can be shared with other nations.

    Adding an adjuvant would delay vaccine production to November, Robinson says, although it might be possible to start making regular vaccine and then switching to production of the boosted product.

    "Just because we have a lot of vaccine doesn't mean we are going to use it," warned Bruce Gellin, MD, MPH, director of the National Vaccine Program Office and deputy assistant secretary of HHS.

    Gellin's point is that making vaccine is one thing, and implementing a huge vaccination program is another. Deciding to make a vaccine requires major decisions:

    • Who should get the vaccine first?
    • How will the vaccine be delivered?
    • How will state and local health departments -- now struggling with huge budget shortfalls and staff reductions -- manage vaccination programs?
    • How can vaccine safety be monitored in real time?

    Another issue is whether swine flu will wait to strike until people get vaccinated. Since swine flu most frequently attacks school-age children, many experts fear there will be a big wave of cases as schools open in the late summer and early fall.

    During the Asian flu pandemic of 1957, Cox says, there was an early wave of flu in September. By the time a vaccine was ready in December, many people had lost interest in vaccination.

    That was a big mistake.

    "A lot of people died when a new wave came through later that winter," Cox says.

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