The government has made significant health care decisions regarding H1N1 vaccination, and right from the beginning it excluded everyone over 65. The exclusion continues and is being justified through government-collected data.
From
MMWR:
Initial target groups
- pregnant women
- persons who live with or provide care for infants aged <6>
- health-care and emergency medical services personnel
- children and young adults aged 6 months--24 years
- persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.
Subset of initial target groups
- pregnant women
- persons who live with or provide care for infants aged 6
- health-care and emergency medical services personnel who have direct contact with patients or infectious material
- children aged 6 months--4 years
- children and adolescents aged 5--18 years who have medical conditions that put them at higher risk for influenza-related complications.
The subset is the most interesting, because that reflects who
really is getting seriously ill and dying from the infection, at least those the government wants to include (see below.) They are basing their decision on the data presented in the following graph:

The blue bars represent seasonal flu (3900 cases,) the white bars represent H1N1 (1148 cases.)
The left (y-axis) is percent of total hospitalized cases that had confirmed influenza. That means some one had to test them, and the report states that this is an under-report. Where I work were discouraged from testing for influenza in the spring, and we have received no guideline regarding testing over the summer. Might the elderly be a group less likely tested? Patients are hospitalized for pneumonia and dehydration. A young person would likely be tested for H1N1 with these diagnoses while an elderly person would not.
The bottom (x-axis) is age groups: <6>65 yrs.
One problem in in combining groups. Yes, the incidence is higher in those <18>65, but several of those individual groups are about the same. And clearly those 18 to 64 are at much greater risk that those <18, style="font-style: italic;">all children are to be vaccinated and only
higher risk adults will be.
The report has statements like, "As of July 31, 2009, the median age of hospitalized persons with laboratory-confirmed novel influenza A (H1N1) virus infection was 20 years, and the incidence of hospitalization was highest among young children aged <4 years (11; CDC, unpublished data, 2009). Only 282 (5%) of 5,514 hospitalizations and 29 (8%) of the 353 reported deaths had occurred among persons aged ≥65 years (CDC, unpublished data, 2009)." [Clinical Features, paragraph 3] Well, what exactly are the percentages for those under 4? How much higher than those over 65?
Another problem comes with decisions based on small studies in which not all the data is given. [Clinical Features, paragraph 4] One small study showed an increased risk of pregnant women, yet two showed increased risk in the obese. The first is amplified ("was four times higher") while the second is down-played ("has been noted," "however patients had other risk factors.") Well, did the hospitalized pregnant women have other risk factors too? How much higher was the rate hospitalization among the obese?
In this study, nine out of ten of the sickest patients were obese. Why are obese children and adults on either of those initial target groups?
This is exactly how the government will play with the numbers, looking at what they want and ignoring what they don't want. We need to ration the vaccine because the government only asked for so much of it to be made in the first place. And for some reason, the US vaccine requires two doses while the Chinese version does not, making our supply even tighter if we plan to vaccinate every child in the country (whether they need it or not.)
We can look for more of this should the government take over health care. Besides, we should not even consider any health care reform without explicit exclusion of funding for abortion and stem cell research. That is where we need to start.
