ワクチン不足がオバマ政権への信頼を徐々に蝕む/米国 新型インフルエンザ 緊急事態宣言

 何ヶ月もかけて計画と準備をしてきたが、ワクチン不足がオバマ政権への信頼を徐々に蝕む可能性がある。
 早くからオバマ大統領は補佐官に対し、「過去の失敗から学ぶ」よう指示してきた。2004年のブッシュ政権時にはワクチン不足が政治的問題となったし、1976年のフォード大統領当時は集団予防接種キャンペーンが失敗に終わり厳しい批判を浴びた。
 6月末にオバマ大統領は1976年当時の経験者をホワイトハウスのルーズベルトの部屋の私的なミーティングに招待し、自身の役割が何であるべきであるかを尋ねた。フォード政権の保健長官であったデイビッドマシューズ博士は、「政府が最優先で取り組んでいるので過度の恐怖や非理性的な反応を起こさないように、極めて現実的に説明をする」よう話した。CDCが46州での広範囲の流行になっている現状で、公衆衛生専門家のオバマ政権に対する評価は様々である。
 ピッツバーグ大バイオセキュリティーセンターのEric Toner博士は、これまでのところ、評価はBという。
 しかし、保健福祉省長官キャスリン・セベリウスは、楽観的なワクチン入手可能性を予測したことで強い批判を浴びている。7月には今月末までに1億2000万本が入手可能としたのに後で4000万本に下げ、その後更に下げた。水曜日にやっと2320万本が使用可能となったに過ぎない。
 オバマ大統領は先週末に国家的緊急事態を宣言し、声明文を公表した。
 伝染病はどんな大統領にたいしても厳しい挑戦状を突きつける。ワクチン生産のペースが回復してワクチンが行きわたれば、大統領は個人的な非難を受けないだろうが、インフルエンザは予測不可能である。重症者の数が多くなければ人々は忍耐できるだろう。
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子どもの死亡 1週間で11人増加 ワクチンの供給不足で感染拡大の予測/米国CDC 新型インフルエンザ
http://kurie.at.webry.info/200910/article_20.html
ブタインフルエンザワクチン 不足の危機/新型インフルエンザ
http://kurie.at.webry.info/200907/article_29.html
30年前の豚インフルエンザワクチンの教訓/米国医療事情
http://kurie.at.webry.info/200905/article_17.html
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Shortage of Vaccine Poses Political Test for Obama
http://www.nytimes.com/2009/10/29/us/politics/29shortage.html
By SHERYL GAY STOLBERG
Published: October 28, 2009

WASHINGTON ― The moment a novel strain of swine flu emerged in Mexico last spring, President Obama instructed his top advisers that his administration would not be caught flat-footed in the event of a deadly pandemic. Now, despite months of planning and preparation, a vaccine shortage is threatening to undermine public confidence in government, creating a very public test of Mr. Obama’s competence.

画像Tim Sloan/Agence France-Presse ― Getty Images
Health and Human Services Secretary Kathleen Sebelius, right, with Homeland Security Secretary Janet Napolitano, at a news conference on the government's response to the H1N1 flu virus.


The shortage, caused by delays in the vaccine manufacturing process, has put the president in exactly the situation he sought to avoid ― one in which questions are being raised about the government’s response.

Aware that the president would be judged on how well he handled his first major domestic emergency, the Obama administration left little to chance. It built a new Web site, Flu.gov ― a sort of one-stop shopping for information about H1N1, the swine flu virus. It staged role-playing exercises for public health officials and members of the news media.

It commissioned public service announcements, featuring the fuzzy Sesame Street characters Elmo and Rosita singing in English and Spanish about “the right way to sneeze.” The president added a swine flu update to his regular intelligence briefing ― he also receives an in-depth biweekly memorandum on the prevalence of the disease worldwide and in the United States ― and appeared in the Rose Garden to urge Americans to wash their hands.

Early on, Mr. Obama told his aides he wanted them to “learn from past mistakes,” said John O. Brennan, Mr. Obama’s domestic security adviser, who has been coordinating the flu-preparedness effort.

Mr. Obama and his top aides studied earlier flu outbreaks, including one in 2004, when a vaccine shortage created a political problem for President George W. Bush, and another in 1976, when President Gerald R. Ford ordered a mass vaccination campaign for an epidemic that never materialized ― and faced intense criticism for it.

In late June, Mr. Obama invited veterans of the 1976 effort to a private meeting in the White House Roosevelt Room, and asked what his own role should be. (Mr. Ford was photographed being vaccinated; Mr. Obama has not yet received his flu shot because children, pregnant women and people with underlying health conditions are being vaccinated first.)

“We talked very realistically,” said Dr. David Mathews, who was Mr. Ford’s health secretary, “about the fine line he has to walk in being responsive and showing people that he cares, and that the federal government is on top of the issue, and on the other hand not provoking undue fear or irrational responses.”

Dr. Mathews advised Mr. Obama, “You’ve got to be willing to take the criticisms for being over-prepared, because there’s no defense for being underprepared.”

Now, with officials at the Centers for Disease Control and Prevention reporting that H1N1 is widespread in 46 states, public health experts and leading senators are giving the Obama administration only mixed grades. “I would give them a B for performance so far,” said Dr. Eric Toner, a senior associate at the Center for Biosecurity at the University of Pittsburgh Medical Center, who has advised the administration on pandemic planning.

The administration gets high marks for its public education campaign, as well as the scientific effort to develop and test a vaccine. “The vaccine was miraculously developed,” said Senator Joseph I. Lieberman, the Connecticut independent who was chairman of an oversight hearing last week on the government’s response to the outbreak.

But the administration, and in particular Health and Human Services Secretary Kathleen Sebelius, have come in for strong criticism from those who say they created a false sense of expectations with overly optimistic predictions about the availability of the vaccine.

“The fact that there are vaccine shortages is a huge problem,” said Senator Susan Collins, Republican of Maine and co-chairwoman of last week’s hearing with Mr. Lieberman. “I believe the administration took the pandemic seriously, but I also believe administration officials were so determined to show that everything was under control that they sent the wrong signals about the adequacy of supplies of the vaccine.”

Ms. Sebelius has said she was relying on estimates from manufacturers, who reported in July that 120 million doses of vaccine would be available by the end of this month ― a figure that was later lowered to 40 million doses, and then lowered again. She said Wednesday that 23.2 million doses had become available, including 9 million in the last week alone.

Accepting the manufacturers’ assurances may have been “nai"ve on our part,” Ms. Sebelius said in an interview. But she said Mr. Obama recognized that the matter was beyond the government’s control. “If we could wave a magic wand or have the tools in our government shop to fix this,” she said, “I think there would be a different expectation.”

For a president whose aides regard him as the best communicator in the administration, Mr. Obama has been relatively low profile during the pandemic. When he declared a national emergency over the weekend, he used a written proclamation. His Rose Garden appearance lasted just five minutes. His last public reference to H1N1 came on Sept. 23 ― one line in a speech to the United Nations General Assembly, in which he promised to contribute vaccine to the World Health Organization.

Anita Dunn, Mr. Obama’s communications director, said the president’s “voice has been heard, and will be heard again.”

But for any president, epidemics pose a tricky challenge. The public typically prefers to get its health information from trusted medical professionals, not politicians. The topic of how the president should engage came up in the Roosevelt Room session about the lessons of 1976.

“We talked about the role of the president,” Dr. Mathews said, “and our advice was, ‘If you’re not visible at all, it seems like a dereliction of duty, but you really need not to get so far out in front that it seems political.’ ”

If the pace of vaccine production picks up, and the shots reach the public in time to keep people from getting sick, Mr. Obama is unlikely to come in for personal blame.

But flu outbreaks are notoriously unpredictable; if the pandemic takes a turn for the worse, the president may be held accountable even for a situation that is beyond his control, said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health.

“Where people start holding political actors accountable is when they develop an expectation for what is to happen,” Dr. Blendon said. “If very few people get sick and those who do are not very seriously ill, the public will have a much higher tolerance than if there are people who are dying.”

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