Should Children Get One or Two H1N1 Flu Shots?

The World Health Organization (WHO) and the United States government are having a fascinating debate about the number of H1N1 flu vaccinations that children under age 10 should receive. Both agree that two shots are better than one. The vaccine is scarce, however, so public health officials have to make hard choices about how to prioritize its use.

As NPR reported a few days ago, the WHO favors giving a single dose to each child because of the vaccine shortage:

“The priority is to give…one dose rather than vaccinate half the number of children with two doses,” says Dr. Marie-Paule Kieny, director of WHO’s Initiative for Vaccine Research.

The National Institute of Allergies and Infectious Diseases (NIAID), however, favors giving two doses to each child:

“One of the dangers in jumping ahead and saying you want to stretch out the supply by giving a single dose to these young kids,” [NIAID Director Dr. Anthony] Fauci says, “is that you’ll be under-protecting them.” If that happened, he says, we wouldn’t be saving a dose for each vaccinated child. We’d be wasting a dose.

Intrigued by this difference in opinions, I took a quick look at some of the newest vaccination data that the NIAID reported last week. Researchers examined the immune response of 583 children who received two doses of vaccine and found the following:

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To use these data in developing vaccination strategies it is helpful (as I repeatedly tell my students) to consider the marginal benefits and costs associated with each shot:

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