updated 10/22/2007 7:12:42 PM ET 2007-10-22T23:12:42

Pregnant women, babies and toddlers would join doctors, emergency workers and soldiers at the head of the line for scarce vaccine if a super-strain of flu triggers the next pandemic, says a draft government plan to be released Tuesday.

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Once more vaccine is brewed, older children along with workers who keep the electricity, water and phones running could be next to roll up their sleeves.

At the end of the line: The elderly and healthy younger adults.

It's a priority list quite different from the usual winter pleas for older Americans to get vaccinated against regular flu. And it reflects growing agreement that curbing a super-flu would require protecting workers who care for the sick and maintain crucial services — plus targeting the people most likely to spread flu, not just die from it.

"Children are not only highly susceptible to influenza, children are also very good at spreading it," said William Raub, emergency planning chief at the Department of Health and Human Services. "Protecting them also protects those in the population."

The list will prove no surprise to state and local health authorities struggling to plan how they would ration vaccine for a panicked population. The Bush administration has long signaled its key priority groups.

But the new draft plan puts a rationale for step-by-step vaccination to paper, opening it to formal debate before the list is finalized — not as set-in-stone rules, but as guidelines for states.

"Some local discretion is going to be imperative here," Raub said.

Pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people have never experienced. Scientists cannot predict when the next pandemic will arrive, although concern is rising that the Asian bird flu known as H5N1 might trigger one if it starts spreading easily from person to person.

Vaccine would take months to make
Vaccine must be custom-brewed to each circulating flu strain, something that would take several months after a pandemic began. The government is stockpiling vaccine against the current bird flu strain in hopes it could offer some protection while better shots are brewed. That stockpile is expected to contain enough for 13 million people by year's end, said HHS spokesman Bill Hall.

The eventual goal is to stockpile enough for 20 million people, roughly the number the draft plan designates to be first in line.

A bigger question is whether health authorities would be physically able to vaccinate that many people — if there are enough syringes stockpiled and plans for how to use them, said Kim Elliott of the Trust for America's Health, a public health advocacy group that tracks the preparations.

"We can't just rest on our laurels that we have priority groups in place. We have to think about how we get it into arms," she said.

The draft plan provides flexibility if the next pandemic isn't as deadly as feared. A more severe outbreak requires more aggressive rationing to protect critical workers, while a milder one could allow for more widespread shots.

Copyright 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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