According to this BBC report about a Nature article, the author's of said article suggest that the public be vaccinated against a possible H2N2 outbreak. Again, according to the BBC report, they suggest that the immunity in those below age 50 is `very low.' Therefore if an H2N2 outbreak occurs, it may have little difficulty in sweeping through the US population with possibly debilitating results. And since a vaccine already exists from a 1950s H2N2 outbreak, we can already produce the vaccine. The alternative options are 1) stockpile the vaccine so that it is ready to go the minute the outbreak is discovered or 2) start producing it once the outbreak is discovered and vaccinate as the vaccine is produced. The BBC reports that the authors suggest that a mass vaccination campaign now is the most cost effective option. [In the Nature comments article, the authors say that it would be a one-time program followed by ongoing vaccination in this point is moot.] One difficulty I have with this approach is that it is not a one-time vaccination campaign as suggested by the authors. It is more similar to the regular vaccinations children receive for measles and other diseases. Yes, it would be a mass vaccination campaign for large segment of the population but then would be ongoing addition to the vaccination schedules for children. Of course the alternative action would be to just have a mass vaccination campaign every 50 years or so, but that doesn't seem like a very sustainable model. The second (and more meaningful) difficulty I have with this approach is that there is so much uncertainty in the future H2N2 outbreak that appears to be unaccounted for. In particular
  • when will a H2N2 outbreak occur?
  • how infective will the strain be?
  • what will the morbidity and mortality be for the strain?
All three of these questions are important to in making a decision about whether to do a mass vaccination campaign. For example, if we don't expect an outbreak to occur in the next 100 years, then it makes no sense to vaccinate. If we expect an outbreak but its infectivity is really low, then it will make sense to start production once the vaccine has broken out. If the outbreak will occur soon and it is highly infective, then it still only makes sense to do a mass vaccination campaign now if the morbidity and mortality of the strain is high. What do we know about these three questions and what is our uncertainty around that knowledge? With that we can create an optimal vaccination plan. P.S. Thanks to my next door office mate who found the article in the comments section of Nature.

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