Priority Setting for Pandemic Influenza An Analysis of National Preparedness Plans 英文参考文献.docVIP

loicPy Forum Priority Setting for Pandemic In?uenza: An Analysis of National Preparedness Plans Lori Uscher-Pines , Saad B. Omer, Daniel J. Barnett, Thomas A. Burke, Ran D. Balicer * R ecognizing the potential severe impact of pandemic in?uenza, the World Health Organization (WHO) urges every country to develop or maintain an up- to-date national in?uenza preparedness plan, and provides guidance on plan content [1]. WHO guidance focuses on numerous issues, from surveillance and communications to prioritization of vaccine. Despite the perceived imminence of this threat, WHO estimated that as of December 2005, only 40 countries had developed written plans [2]. Among these plans, there was a great deal of variation with respect to comprehensiveness, quality, and stage of completion [3]. ritoiizrinPg Scarce Resources Prioritization of scarce pharmaceutical resources (e.g., vaccines and antiviral medications) that could ultimately delay the spread of a pandemic or lower overall incidence is of particular importance to planning at the DOI: 10.1371/journal.pmed.0030436.g001 Figure 1. Vaccine Priority Groups by Development Status—Listed in at Least Two National Plans India, and China produce oseltamivir, some for local use as determined in of?cial agreements and some for use in areas without patent protection [6]. It seems that the world is entering a phase in which pharmaceutical interventions will not be limited to the developed world—e.g., by spring of 2006, 65 countries had ordered stocks of oseltamivir [7]. Thus, prioritization is crucial for all nations. national level. Because of costs and manufacturing limitations, these critical resources are likely to be scarce and will require evidence-based rationing. At current capacity, we cannot expect to vaccinate more than 14% of the world’s population within a year of a pandemic [4]. Similarly, although manufacturing capacity has recently quadrupled, it is estimated to take a decade to produce enough of the antiviral