Press Briefing Transcripts

Weekly 2009 H1N1 Flu Media Briefing

October 27, 2009, 1p.m.

• Audio recording (MPEG)

Operator: Welcome and thank you all for standing by.  At this time, I would like to remind parties are in a listen-only mode until the question and answer session at which time you may press star 1 to ask a question.  Today's call is being recorded.  If you have any objection, you may disconnect at this time.  I'll turn the call over to Glen Nowak. Thank you, sir.  You may begin.

Glen Nowak: Thank you, and thank you for joining us, either in person or on the phone.  This briefing today, focuses on H1N1, both the disease and the vaccine supply.  The briefing will be conducted by Dr. Thomas Frieden, the Director of the Center for Disease Control and Prevention.  I'll turn the podium over to Dr. Frieden to make some opening remarks and answer your questions.  Dr. Frieden? 

Thomas Frieden: Good afternoon, everyone. As of today, H1N1 influenza remains widespread throughout the United States and although we have seen some areas have decreases in disease, we are also seeing increases continuing in other areas.  We continue to track the pattern of illness and there's been no change in the pattern of what age groups are affected or what people are most seriously affected by H1N1, there's also been no change in the laboratory testing of the virus.  So there's been no difference in the likelihood that the virus strains that are in the community will respond to the vaccine that's been produced and distributed and there's been no change in the virus that would suggest it would be more deadly at this time.  While it's still too hard to get the vaccine, vaccine is becoming significantly more widely available. 
This week, as of today, we have 22.4 million doses available for shipment out directly to providers and we're getting to the level where it will become significantly easier to find and receive vaccine.  We're working closely with the states to ensure that vaccine, once it becomes available, is ordered, delivery is overnight directly to the provider.  And eventually, there will be enough vaccine for all who want to get vaccinated to get vaccinated.  We wish we had more vaccine available now.  We wish it had been available weeks or even months earlier but we're beginning to get to a significant increase in the availability.  If you just look from last week to this, we went from about 14 million doses last Wednesday available to today, 22.4 million, that's an increase in 8 million doses in about a week or less than a week.  That allows enough vaccine to be available in states and localities that it can be increasingly widespread.  That's good news, not as soon as we would have liked it, but it does represent a significant advance.  We're also working with states and localities to identify best practices because having the vaccine out even though it's not in as large quantities as we would have wanted, does mean that we have to work hard to ensure that what is available is given and to the priority groups as conveniently as possible. 

One of the key areas is school located clinics.  Some jurisdictions have done things such as have community forums, have community leaders coordinate this, sent consent forms home by regular mail as well as e-mail.  Conducted vaccination programs during school hours when it's more convenient for people to get vaccinated.  All of these are important and in general, trying to make vaccine as easy for people as possible whether it's in their doctor's offices or as more becomes available in pharmacies or in schools or for health care workers in particular in workplaces, these are all important  opportunities, also it does seem that people are getting more used to the nasal mist that's available.  In past years there had been some reluctance to use it, it's recommend for people between the ages of 2 and 49 who do not have underlying health problems.
We wish we had better technology.  We wish he had a technology that could produce a vaccine in weeks or months rather than the 6 to 9 months it takes given the current tried and true technology.  Everyone in the supply chain is working hard.  Manufacturers, government, distributors, health departments, providers and the public and I think all of us are frustrated that we haven't had more vaccine that we don't have more vaccine now. 

When the season is over it will be a good time to look back and think of what could have been done differently or better.  Clearly, the vaccine production technologies need to continue to improve.  We're still using eggs.  We're still using technologies that have been around for a long time, that's good news in terms of safety.  We're not cutting any corners, we're not trying anything new or experimental in this season, but we wish we had vaccine technologies that could be quicker.  We also are struggling with complex vaccine manufacturing process and the procurement and distribution process and figuring out how that can work best is also something that's worth looking at carefully.  But there's a lot that the also gone quite well.  Six months after the virus emerged, we have a vaccine available increasingly.  We have high degree of confidence in its safety.  It's an excellent match with the strains of virus that are circulating.  We did not cut any corners in terms of vaccine safety.  All of the safeguards are being used, we're using the same production method, the same factories, the same companies, the same safeguards to make a vaccine that's been used for hundreds of millions of doses with excellent safety record.  And while we know that there will inevitably be events that occur after vaccination we'll have a system in place to determine are whether those events are by chance or whether they may reflect any problem with the vaccine.  So we take vaccine safety very seriously. 

Two final -- or three final points.  First, that this is a collaborative effort.  Many parts of the federal government are involved, manufacturers are involved, the health care providers, the health departments who have been central in ordering, identifying providers and distributing the vaccine and the public in identifying and prioritizing people at high risk to get vaccinated as soon as vaccine is available, even when vaccine is available and particularly in places where it's not as widely available as we would like, it's very important to remember that treatment can be highly effective.  And if you are severely ill, having trouble breathing after having flu or if you have an underlying condition like heart disease, asthma, then you should be treated promptly and see your provider right away if you have fever and flu-like illness.  And of course, very effective, always in preventing the spread of flu and protecting yourself and others is to stay home if you're sick, to cover your cough and sneeze and to wash your hands frequently.  So while we still have many people who want to get vaccinated and don't yet have ready access to the vaccine, we will be seeing in the coming weeks, significant increase in vaccine availability and predictably there will be challenges in ensuring that the vaccine that is available gets to the people who want to get vaccinated and I expect that will be a challenge in areas more than others.  This is something that is never easy.  And particularly when there is the level of concernand interest in vaccination that there is now and so we're very grateful that the excellent work is being done at all levels by states, by providers and that people understand that this will likely take more time than we would all have liked.  Thank you, we'll take some questions starting in the room. 

Diana Davis: Thank you.  Diana Davis from WSB in Atlanta.  You've mentioned several times about the outdated production technology.  Rather than eggs, what would be an improvement?  Would it be genetic engineering, synthetic?  And do other countries use this? 

Thomas Frieden: There are several other potential vaccine manufacturing mechanisms, cell-based is one, DNA technologies are others, protein-based are others.  They're all still experimental, we're not using any of them in this and I'm not aware of any other country that's using the new technologies there.  Is some use of adjuvant in other parts of the world, we've opted not to use it here. 

Mike Stobbe: Hi, doctor. Mike Stobbe from the AP.  You said swine flu illnesses are increasing in some parts of the country and decreasing in others.  Could you be more specific, where is it increasing and decreasing?  Could you put us in context?  Are we in, would you call this the second wave right now or is the second wave still in the future? 

Thomas Frieden: You could say that we've had one flu season that's been continuous from April to now.  But there was a lull over the summer with fewer kids in schools and now that summer has ended and kids are back in school, more cases.  We're seeing decreases in Georgia as was reported in the press. The increases quite local, so it's not one region or one part of the state.  But parts of state, different parts of the city are seeing the spread at different times.  This consistent with influenza, it’s not a very consistent pattern, it tends to be somewhat patchy.  That's important because it means that although many people have had H1N1 influenza and we wish there had been vaccine for them earlier, there are still many people at risk and it is certainly not too late to get vaccinated when vaccine becomes available.  In terms of the detailed information, we make that available each Friday on FluView. 

Betsy McKay: Hi, Dr. Frieden, Betsy McKay from the Wall Street Journal.  I'm just wondering if you have thoughts on what can or should be done to make more vaccine available more quickly right now or if you think that needs to be done?  Thinking of expanding who can get nasal mist or different formulations.  And then the other question just logistically, do you know how long it takes from the time a manufacturer ships vaccine to the point that you're able to say that you have it available for states to order? 

Thomas Frieden: So the shipping goes directly to a set of warehouses.  They're logged in at the warehouse and becomes available for ordering for within about a day.  This then shipped overnight once the order is received.  We've cut as much cycle time out of that process as possible.  Every single shipment is checked to ensure that the temperature has been maintained at every step of the way so hasn't gone out of temperature and in terms of the just trying to get the vaccine out as rapidly as possible, the challenge is work at the state and local and provider level to ensure that when vaccine is available it becomes known to those for whom it's a priority to get vaccinated, that information is increasingly available at flu.gov through a flu locater.  There are other states and localities that have other information.  Different states have chosen different routes to try to get vaccine out widely.  Many have used providers.  So it's a question of providers signing up and receiving their allocation of vaccine.  We anticipate in the next week or so, there will be a significant increase in the perceived and real availability of vaccine as we go from the 10 to 15 million range to the 25 million range in terms of doses in the community.  That should provide a significant difference.  Remembering that in a normal flu season, we vaccinate about 100 million people over about four months.  So roughly speaking that's 20 million to 30 million doses per month.  So having more than 20 million doses out, we think, will provide some greater availability of vaccine for a lot of people.  On the phone? 

Operator: First question is from Helen Branswell, the Canadian Press, your line is open.

Helen Branswell: Hi, thanks for taking my question.  I would ask a question and follow-up if I could, please.  You know the people who don't want vaccine are quite vocal about their concerns about the vaccines, but the lineups you're seeing in the United States also speak quite loudly.  I'm wondering if CDC has any kind of current data from polling that you've done that gives you a sense of how willing Americans are to get this vaccine, where things stand at this point?

Thomas Frieden: We do have steady polling information.  And the results are interesting.  First there's still widespread in getting vaccine.  There are some people, as you note, who really don’t want to get the vaccine.  They've made that clear.  That's their choice.  Interestingly, if you compare attitudes towards seasonal vaccine versus H1N1 vaccine, there's some things that are puzzling in the public perception.  That I think that I mean that all of us need to continue to emphasize certain messages.  One is that there is a difference in the confidence in the effectiveness of seasonal versus H1N1 vaccine and we have every reason to believe that the H1N1 vaccine is an excellent match with the virus that's circulating and that it will be highly effective as effective as a highly effective flu --seasonal flu vaccine.  Second, there are more concerns about safety, with H1N1 vaccine than there are with the seasonal flu vaccine.  Again, we've said it, I don't know how else we could say it but it's the same manufacturing process, it's the same factory, it's the same safeguards and if we had had H1N1 earlier in the season, we would have most like included it in the seasonal flu vaccine so it would have just been part of the regular seasonal flu vaccination program as it will be for the southern hemisphere in the coming flu season.  There's also the perception that seasonal flu is riskier or more likely to be a problem than H1N1, where we really don't know what the future will hold.  We do know that H1N1 is very widely circulating now, the rest of the flu season, we'll only know what will happen later on in the year.  But certainly, H1N1 is the dominant strain circulating now and there's every reason to be vaccinated if you're in a priority group as soon as the vaccine becomes available.  Did you have a follow-up question to that? 

Helen Branswell: I do have a follow-up question.  Earlier, you talked about the production technologies and challenging they are under these circumstances.  And last week, when you had your press conference, you also said the technology we are using although tried and true is not well suited for pandemics.  Once this is over, do you think it's time to decide that egg-based vaccine production really cannot answer the needs of a pandemic? 

Thomas Frieden: That's not a question of deciding.  It's a question of investing in the research and the technology development to come up with new vaccines and try to get those into our seasonal flu production process.  We need to get comfortable with a new vaccine process.  I don't think any of us would want in an ideal situation to try a new vaccine during a pandemic.  What it tells us is that there's an important need for ongoing significant investment in new vaccine technologies.  Next question from the phone.

Operator: The next is from Maggie Fox from Reuters.  Your line is open.

Maggie Fox: Thanks very much.  I want to follow up on this question about the perceptions about the vaccines, is it frustrating to you that people on the one hand are saying, hey, we can't get this vaccine but then there's plenty of people saying don't get the vaccine it's dangerous.  I know the last time that there was a shortage of vaccine, you ended up throwing doses away.  Is there a risk of that happening here? 

Thomas Frieden: I think the likelihood is that we are currently in a situation where we too little vaccine in the community.  It's quite likely that that too little vaccine is one of the things that's making people more interested in getting vaccinated, frankly.  When we have shortages we see an increase in demand.  It is likely also as we produce more vaccine and as most people are given the opportunity to get vaccinated, and as disease maybe wanes in the future, we will have significant amounts of vaccine that can't be used.  The challenge at this point is to get what vaccine we have out now available to people, provide it to doctors offices, school, health care facilities and others as rapidly as possible so that as much as is available can be used.  One of the messages for states, localities and health providers is not to reserve vaccine that they have available, to give it out as soon as it comes in, because more is on the way.  And the production is now in a scaled up mode, so more is being produced, not as much as we would like, but more is being produced and made available as soon as it can be.  Another from the phone? 
Operator: The next is from Miriam Falco of CNN Medical News. Your line is open.

Miriam Falco: Hi, Dr. Frieden, thanks for your taking the question.  CNN opinion poll only had 49% thinking the vaccine was safe.  My question is do you think you'll meet the downsized goal of 28 to 30 million doses by the end of next week which is the end of the month? 

Thomas Frieden: We're at 22.4 million as of today.  On Friday, we'll let you know what is achieved as of Friday.  Is there a question in the room? 

Beth Galvin: Beth Galvin Fox 5 News.  Thank you for doing this briefing.  I'm wondering for Americans who are trying to get the vaccine and feeling frustrated, when do you think it will be widely available for people who don't fit into a high-risk group but really do want this vaccine? 

Thomas Frieden: Our focus is really is the high-risk groups at this point.  These are the groups most likely to bet severe illness, most likely in the case of children, to spread severe illness.  That's the focus now, while others I understand want to get vaccinated, I think all of us can respect that the vaccine should be used first for those who will benefit most, those who are most at risk.  Those children who are between six months of age and young adults 24 years, anyone with an underlying health condition, health care providers who provide care for those who are ill, those who provide care for people under the age, infants under the age of 6 months.  Those are the groups at the highest risk of severe illness and highest priority for vaccine.

Beth Galvin: Can I just follow up and ask about widespread availability.  Do you have any idea when we'll have a substantial amount for people? 

Thomas Frieden: Significantly more vaccine is becoming available.  I do anticipate that in most states within the next couple of weeks, it will seem to be much more widespread and much easier than it is now to get vaccinated.  The big increase from last week to this week in vaccine availability translates into more vaccine availability in the community from this week to early next week and increasing widespread availability after that.  On the phone? 

Operator: The next is from Elizabeth Weise from USA Today.  Your line is open.

Elizabeth Weise: Thank you for taking my call.  I want to check on the numbers you were are giving for vaccine is that cumulative or just new out this month or this week? 

Thomas Frieden: Cumulative.  So as of today, 22.4 million doses are available for ordering or basically can be shipped -- the way the process works is that the manufacturers ship it to the central distribution place, they log it in, ensure that the cold chain has been maintained every step of the way, make it available for ordering, the orders are placed by the states, then the orders go directly from the manufacturer in most cases, directly to the provider, whether it's a hospital or a clinic or a private doctor's office, or a health department.  On the phone?  And then in the room. 

Operator: Amy Burkholder from CBS News, your line is open. 

Amy Burkholder: Yes, hello, thank you, Dr. Frieden.  Quickly, the CDC's algorithm for distributing the vaccine, is that based on population only and not where the illness is most acute and is that effective? 

Thomas Frieden: Our decision was to provide it on a per capita basis so each state can purchase and each state has an equal likelihood of being able to get the vaccine.  One of the characteristics of using the distribution system that we are using is that it's not reliant on the market, so it's not that if you're a provider or a drugstore or a hospital has a better relationship with the distributor or manufacturer, they'll be at the front of the line, everyone has the same chance of getting the vaccine that's available.  I'm sorry, the other part of that question was? 

Amy Burkholder: The second question and that do people who say they're frustrated by either a lack of updated information on the flu.gov link or some unreliable information on where to get the vaccine, you would respond? 

Thomas Frieden: It's challenging with a limited amount of vaccine for a lot of people who want to get vaccinated.  And this means that asking your provider, checking with your health department, checking on flu.gov may be necessary whereas we wish it would be easier for people to find out where they could easily get vaccinated.  In the room? 

Mike Stobbe: Mike from the AP again.  Doctor, you just told us some stuff that suggests maybe good news on the horizon, there's more vaccine becoming available, reduction in cases in some parts of the country, but over the weekend, we had the emergency declaration from President Obama which suggests the anticipation that things are going to get worse.  Can you tell me what triggered that declaration?  Where are we?  What are we anticipating in the next month or two? 

Thomas Frieden: It's really a preemptive move that gives the government and providers another tool they can use to respond if they need to deal with a large influx of patients coming in.  So there are some hospitals that are challenged and this is preemptive or preparatory step, it's not a response to anything that worsens over the past few days or weeks.  It's the ability, it strengthens the hand of the government to respond as we go forward in the season.  One more question from the phone? 

Operator: Stephen Smith, the Boston Globe, your line is open. 

Stephen Smith: Good afternoon, thanks for taking the call.  The Roman Catholic archdiocese of Boston this afternoon is going to announce that it is recommending to parishes that they stop providing communion holy wine through the chalice and also recommending that parishioners not extend physical greeting of peace that typically happens during the mass.  I was hoping to get your sense of the necessity of adopting such measures?  And I'm also curious as to whether you're hearing in other archdiocese and other denominations whether similar measures are being undertaken in an effort to curtail the spread of the H1N1 virus? 

Thomas Frieden: A variety of things are being done in different communities and by different groups to reduce the potential risk of getting influenza or other infectious diseases.  I wouldn't want to comment on any particular denomination or group's decision.  Only to say that sensible means are important and effective. Stay home when you're sick.  Cover your cough and sneeze.  And wash your hands frequently.  This is a challenging time.  We wish we had more vaccine available.  As you know, we had anticipated having significantly more available by now than we do.  And that's been frustrating to all of us.  We are, though, beginning to see significant increases in vaccine production, distribution and we think it will get easier to find vaccine in the weeks that come.  So thank you all very much for your interest and we look forward to continuing to provide you information as soon as we have it available.  Thank you very much. 

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES