The Department of Health and Human Services released long-awaited details on who would get vaccinated and when if a serious global influenza epidemic emerged.

The plan put a million health care workers, such as emergency room staff and nurses skilled in vaccinating others, at the top. Next were military and “mission critical” personnel, public health workers and hospital and nursing home staff.

All of these play a “critical role in providing care for the sickest persons; highest risk of exposure and occupational infection,” the plan read.

“This guidance is the result of a deliberative democratic process,” HHS Secretary Mike Leavitt said in a statement. “This document represents the best of shared responsibility and decision-making.”

Many public health experts believe some sort of influenza pandemic is inevitable, although no one can predict when it might come and how severe it may be.

Likewise, it is impossible to predict what strain of flu might cause it, although H5N1 avian influenza is the main suspect now. It has become entrenched in birds in Asia, Europe the Middle East and possibly Africa.

So far, 385 people have been infected with this virus since 2003 and 243 have died. Experts fear that by mutating, H5N1 could acquire the ability to spread easily from one human to another, setting off a pandemic – a serious global epidemic.

A severe pandemic could kill hundreds of millions of people, disrupt society and wreck economies.

WAITING MONTHS

Since it would take many months to produce enough vaccine to protect everyone, experts agree a plan is needed to determine who gets the first doses.

The HHS plan designates 700,000 “deployed and mission critical personnel” to follow the key health care workers. After that, 300,000 public health workers, 3.2 million inpatient health care providers, 2.5 million outpatient doctors, nurses and other professionals, and 1.6 million long-term care workers would be next to get the vaccine.

“It should be noted that during the 1918 pandemic, more American soldiers died of illness than in combat during the First World War,” the plan says.

Emergency services, law enforcement, makers of pandemic vaccines and drugs, pregnant women and babies and toddlers are also in the first designated groups.

“The need to target vaccine to maintain security, health care, and essential services will depend on how severe the pandemic is, as rates of absenteeism and the ability to supply essential products and services will differ for more and less severe pandemics,” reads the plan, available at www.pandemicflu.gov/vaccine/allocationguidance.pdf.

“As a result, groups targeted for earlier vaccination will differ by pandemic severity.”

Healthy adults not in any other priority group come last.

“The ultimate goal of the pandemic vaccination program is to vaccinate every person in the United States who wants to be vaccinated,” the plan reads.

At least 16 manufacturers in 10 countries are working on vaccines against H5N1. Antiviral drugs can help protect people but they are also in short supply and the U.S. plan also calls for closing schools, limiting public gatherings and other measures to prevent flu transmission.

(Editing by Alan Elsner and Will Dunham)