CONSIDER THIS scenario: news breaks that the widely expected influenza pandemic has erupted somewhere in the world. In Canada, as in many countries, the race begins to produce a vaccine to match the particular strain that’s starting to claim lives at an alarming rate. With luck, three months pass before the first cases are identified here. Perhaps another three months later, with the media din growing by the day, Canada’s first doses of vaccine are ready. When those shots are available, public health authorities make sure those people most at risk are at the front of the line—but that doesn’t include the vast majority of kids. Anxious parents are told to be patient for several weeks more. Many will likely keep their kids home from school or daycare, either because they have been told to by public health authorities, or simply out of fear.
This sketch is based on interviews with doctors working with the federal Public Health Agency of Canada on pandemic planning. They stress that there are plenty of big factors still in doubt. For example, how quickly will the vaccine be produced? What segments of the population will be hit hardest, and in which parts of the country? Will one shot or two be needed to inoculate someone? Still, based on their study of past flu epidemics, PHAC has divided the population into five priority groups for vaccinations—and the place of children in that plan might surprise many.
Health-care workers come first, about 600,000 of them, because they have to take care of those who get sick. Next come a million essential-service providers, including police, firefighters and funeral directors.
Children six months to two years old are in a third group of more than 8 million (flu vaccines aren’t recommended for babies younger than six months), along with nursing home residents and anyone with a highrisk health problem. The fourth group is made up of 8.7 million healthy adults. And finally, making up the fifth and lowest priority group, come healthy kids older than
‘WE KNOW we
have a lot of public education to do,’ one public health official acknowledges
two—who will likely have waited weeks, perhaps months, before it’s their turn.
All this while tens of thousands are dying, if the grimmest predictions for the flu pandemic come to pass. When it comes to managing the fears of anxious parents, “we have a lot of public education to do,” admits Dr. Joanne Langley, a PHAC adviser and professor of pediatric medicine at Dalhousie University in Halifax. Health officials are just beginning to grapple with the challenge of explaining to parents why most kids don’t come first—or even second, third or fourth.
Among the facts driving the vaccination
plans: despite the fact that children six months to two years old tend to be hospitalized with the flu as frequently as seniors, statistically they are less likely to die. And kids older than two are least likely to suffer “severe outcomes,” partly, Langley says, because even healthy middle-aged adults can have underlying medical problems that make them vulnerable.
Dr. Arlene King, co-chair of PHAC’s pandemic influenza committee, stresses that should the pandemic hit kids harder than expected, the priority plan will be changed on the fly. But a related concern for families will be the prospect of school and daycare closures, ultimately a decision for local authorities. A PHAC working group is looking at when these should happen, along with other issues involving quarantining those infected. The reality, though, is parents are likely going to have to stay home with children in many cases. “Inevitably,” says Langley, “it’s going to cause disruption.”
That’s putting it mildly. PHAC’s working assumption is that up to 35 per cent of the population could be stricken in a flu pandemic. That’s roughly 10 million people. Nobody knows when a pandemic might happen—and some experts doubt it will. But if it does, having a detailed plan for treating the sick and inoculating the healthy will be only half the battle. The other half will be convincing Canadians that the hardest public health decisions—especially the ones involving children—make sense. I
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