Tuesday 2 November 2021

Pediatric doses

It sounds like the Government is easing the ground for there to be no vaccination of 5-11 year olds before February. 

They're insisting on MedSafe approval, but haven't encouraged MedSafe to actively seek an application. 

And they're now raising worries about pediatric vials and whether there will be supply constraints - without, as best I can tell, having put in any conditional purchase orders. And this could have been done at any time for months. You order the doses while making delivery conditional on approval. We've known that they'd be running trials for kids since what, May? Could have put in a pre-purchase agreement saying that, if there'd be different packaging or formulation, we wanted to buy enough doses for all the kids here. 

But I also don't get why adult doses can't be diluted. It really doesn't sound hard. I'm probably missing something basic.

As I understand it, the pediatric dose is just 1/3 of the normal dose. The pediatric packaging just makes it easier to dilute to that dose. 

I understand that a standard adult vial has 6 adult doses in it, which they dilute up before administering. 

Vaccination centres could be instructed to take only 4 adult doses from that vial. 

That would leave two adult doses in the vial: one third of the original amount. Dilute the vial a second time, filling it up with saline (or whatever they dilute with - I'm not that kind of doctor) until it's back up to where it was when they diluted it the first time. You now have a vial with six pediatric doses in it, diluted for use. 

Why doesn't that work? Or, at least, why couldn't it work as stopgap, on prescription by a GP for kids with underlying conditions that put them at risk, until pediatric-packaged doses show up in the fullness of time?

Meanwhile, Kate MacNamara's piece on how the government's comms effort on vaccines helped gaslight the whole country last year is a must-read. You should fully expect exactly the same comms effort in trying to convince us that there's no need to hurry in getting vaccines for kids. 

A snippet:

Along the way, the public was fed a soothing version of events shaped by outside PR help, the funds for which the Cabinet signed off in May.

Karl Ferguson, a full-time public relations specialist and serial government contractor, through his firm, Arkus Communications, was paid some $133,600 to work with the taskforce, for what MBIE describes as four months of full-time work (contacted by the Herald, Ferguson declined to comment on the work). It bears noting that it wasn't until August 10 that Cabinet funded Belly Gully negotiators and any actual vaccine purchasing.

What the Government got from Ferguson was communications that controlled and shaped the flow of information around vaccine procurement. Some of the work entailed co-ordinating the public relations teams across different government agencies, and some of it involved gauging the public's appetite for vaccines and promoting their ultimate use.

But Ferguson's work also created Ministers' messaging, and helped to time and promote it in politicised ways, both through the media and through commentators in wider civil society. Its ultimate effect was to achieve a singular and flattering version of events. It is a picture that emerges from a range of government documents, primarily MBIE's weekly report for the vaccine strategy, sent to Ministers, and released under the provisions of the Official Information Act.

The report for September 11 notes that Ferguson was even working with the Ministry of Foreign Affairs (MFAT) in order to alert Ministers and officials of developments abroad - likely the signing of advance purchase agreements for vaccines - that might prompt pointed questions about why New Zealand had none at the time.

You will want to read the whole thing.

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