Questions, lessons on H1N1 virus

A lot of good people are working hard to guide the nation through the H1N1 flu epidemic as safely as possible, from Health and Human Services Secretary Kathleen Sebelius on down through state and county health departments and school districts. They surely are saving lives during this first pandemic in 40 years, through the impressive public information effort and otherwise.

But the outbreak has taxed the public health system, generating questions and complaints as well as — we can hope — lessons for next time.

Sebelius looks bad for having promised far more vaccine than could be delivered by the end of October; though she said in July that 120 million doses would be available by now, only 23.2 million doses have materialized.

With so much advance notice, why are so few doses available? We've heard about the time-consuming process of growing the virus in chicken eggs, and of glitches in production lines. Fast-tracking the vaccine apparently was impossible (and would anybody want one that had been rushed?). It's harder to understand why companies couldn't expand the vaccine-production capacity at the outset (though at least one company cited a shortage of chickens). It isn't comforting that four of the five manufacturers of H1N1 vaccines are foreign. As Sebelius told Congress last week, the United States needs to expand its manufacturing capacity.

Anytime there isn't enough vaccine for all who want or need it, there's going to be trouble. The distribution has raised questions of fairness, geographical and otherwise. Sedgwick County Commissioner Karl Peterjohn observed at Wednesday's meeting that cities on the coasts are vaccinating children, for example, while there are only enough doses locally so far to cover pregnant women and health care workers at Sedgwick County's special clinic. "I'm very concerned that we are not getting our fair share," Peterjohn said.

And shouldn't pharmacists and their employees be counted among the health care workers getting priority for the vaccine in Sedgwick County? If those stricken with H1N1 aren't at a physician's office, the emergency room or at home in bed, they're going to be at the drugstore, coughing across a counter at a pharmacy employee.

The rollout of the H1N1 vaccine should underscore the need for more research aimed at producing vaccines faster, probably through a process involving cell cultures. In a Boston Globe commentary, former Massachusetts public health official Tom Lyons fretted that "there's a risk that we will not see the need for continued investment in this type of research once the present crisis abates."

When it does, government and pharmaceutical companies will need to figure out how to be more timely in countering the next threat.

This may not be the Obama administration's Hurricane Katrina, as some have suggested. But the vaccine should be faster than the virus in reaching Americans, not the other way around.