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The WHO has just declared that it does not see a mass-produced swine flu vaccine until next year at the earliest. First, the whole news story.  Then, my usually concise and brilliant commentary.

WHO: No licensed swine flu vaccine til end of year

By MARIA CHENG – 4 hours ago

LONDON (AP) — A fully licensed swine flu vaccine might not be available until the end of the year, a top official at the World Health Organization said Monday, in a report that could affect many countries' vaccination plans.

But countries could use emergency provisions to get the vaccines out quicker if they decide their populations need them, Marie-Paule Kieny, director of WHO's Initiative for Vaccine Research, said during a news conference.

The swine flu viruses currently being used to develop a vaccine aren't producing enough of the ingredient needed for the vaccine, and WHO has asked its laboratory network to produce a new set of viruses as soon as possible.

So far, the swine flu viruses being used are only producing about half as much "yield" to make vaccines as regular flu viruses.

Last week, WHO reported nearly 95,000 cases of swine flu worldwide including 429 deaths. Most people who get the virus only experience mild symptoms and don't need treatment to get better.

In a presentation to WHO's vaccines advisory group last week, Kieny said a lower-producing vaccine would significantly delay the timeline for vaccines. That could complicate many Western countries' plans to roll out vaccines in the fall.

British Health Minister Andy Burnham promised that vaccines would start arriving in the U.K. in August — and predicted the country could see up to 100,000 cases a day by the end of that month.

Before countries can start any mass swine flu vaccination campaigns, the vaccines need to be vetted by regulatory authorities for safety issues. That means testing the vaccines in a small number of humans first, which can take weeks or months.

"I think it will be a very significant challenge to have vaccines going into peoples' arms in any meaningful number by September," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "At this point, it is still is an issue of when will it be available, who will get it, and what will be the dose?"

Kieny said many of those questions remain unanswered at the moment. But she said WHO's vaccine advisory group recommended that health care workers receive the first swine flu shots since they are on the front lines of the global outbreak.

On Monday, British health authorities said a family doctor died over the weekend after contracting swine flu.

WHO's vaccine experts recommend that countries decided that certain groups should get the vaccine first — like pregnant women, people with chronic respiratory problems or obesity, children, and possibly young to middle-aged adults, who have been disproportionately affected by the virus.

The decision to start vaccinating people against swine flu — which so far remains a mild virus in most people — will ultimately be a gamble, since there will be limited data on any vaccine. Until millions of people start receiving the shots, experts will not know about rare and potentially dangerous side effects.

The public health community may still be scarred by the U.S.' disastrous 1976 swine flu vaccination campaign, which was abruptly stopped after hundreds of people reported developing Guillain-Barre syndrome, a paralyzing disorder, after getting the flu vaccine. (bold mine)

Several drugmakers are currently considering using adjuvants, ingredients used to stretch a vaccine's active ingredient, which could allow for many more vaccine doses. But little or no data exists on the safety of vaccines with adjuvants in populations including children and pregnant women. And in the U.S., there are no licensed flu vaccines that use adjuvants.

Copyright © 2009 The Associated Press. All rights reserved.

I bolded the reference to 1976 because it is relevant.  In 1976, several people contracted Guillain-Barre syndrome and died.  As a result, the vaccine was pulled from production.  And yet, when A/Victoria broke out in early 1977 at a nursing home in Miami, the only vaccine available was the bivalent swine flu shot.  They broke it out and never saw a statistically significant rise in Guillain-barre, even though it was the same vaccine!  Why has never been determined.

Haste makes waste.  A hastily-manufactured vaccine can bring its own batch of problems and issues.  And now we  see where this virus simply does not like to be cultured.  Not "cultured" as in Shakespeare, although I suspect we will see Shakespearian tragedies and heroism before this pandemic is finished.  I mean "cultured" as in grown in a Petri dish, or in this case grown in chicken eggs.

The first doses of swine flu vaccine that rolls off anyone's assembly line will be directed at first responders and medical personnel.  Doctors, nurses, police and fire and EMS/EMTs will be the first to get the shots.  So will National Guard troops, I suspect.  Then will come the high-risk groups, beginning with anyone from age 5 to 50.  Then will also concurrently come persons with high risk factors, such as HIV, lupus, diabetes, cancer patients on chemotherapy, persons with other auto-immune disorders, persons with COPD, and so on.

And as of today, it is highly doubtful if any of these shots will come before the first of the year.  With the pandemic's first wave still underway and its second wave forecast for autumn, that means we will be well into the second wave before any vaccine hits the masses.

In the sensational book Good to Great, author Jim Collins speaks of the Stockdale Paradox.  The late Admiral Jim Stockdale was a Vietnam POW.  How did he get through several grueling years as a captive?  By always having hope, but not having false hope.  He knew he eventually would be released or rescued, but he never latched onto transient, false hope as some of his fellow POWs did.  He never bought into "We're going home by Christmas!  Did you hear?" or "I heard the armistice is close at hand!" Admiral Stockdale simply kept going, day to day, resolved his situation would improve, yet never pinning his belief on false hope.  This apparent paradox of hoping without hoping also needs to be our mantra as the fall approaches and things turn decidedly for the worse.  We do what Momma taught us.  We cover our cough or sneeze with our sleeve; we wash our hands thoroughly; and we keep a respectable distance from strangers.

So don't pin your hopes on a vaccine that might not come until the pandemic's second wave has returned.  Focus on the things you know work and share those things with others.  Eventually, there will be a vaccine.  But do what needs to be done until (and during and after) that time.