State health officials want the public's views on deciding who should get vaccinated — and who should not — against the next flu pandemic that reaches the Islands.

So far, a wide-ranging advisory group of about a dozen community members representing religious groups, the chamber of commerce and even an expert in mediation have been working to set up a system that will help determine who will be inoculated first and who will have to face the pandemic unarmed, at least until more vaccine can be manufactured and shipped to Hawai'i.

The final determination will rest with Gov. Linda Lingle.

"The decision is with the governor," said Lingle spokesman Russell Pang.

There is no way to stockpile vaccine for an unknown virus that has yet to arrive. And no way to calculate how much vaccine will be needed, how many people will be infected and how many could die, according to Bill Gallo, senior management official with the Centers for Disease Control and Prevention in Honolulu.

So it could take months before federal officials isolate the virus, create a vaccine for it and send it to Hawai'i.

By then, untold lives could be lost.

"It is a very sobering scenario to be thinking about," said Jim Tollefson, president and CEO of the Chamber of Commerce of Hawai'i who sits on the advisory committee. "But it's best to be prepared and educated."

The 20th century saw three pandemics and several more "pandemic threats" that ranged from the Spanish Flu that killed 50 million people worldwide and at least 1,300 people in Hawai'i between 1918 and 1920, to the modern-day threat that the avian flu could spread from Asia to the Islands.

Several hundred people were infected with avian flu in Asia, six died and more than 1 million chickens were slaughtered in an attempt to control the spread of the disease.

"If (the next pandemic) is not here now, it will be here someday," said Dr. Vivek Nerurkar, interim chairman of the department of Tropical Medicine and Infectious Diseases at the University of Hawai'i's John A. Burns School of Medicine. "When a pandemic comes to Hawai'i, it's going to affect a considerable amount of people, especially the elderly and children."

Nerurkar is not involved with the planning and preparations to decide who will be vaccinated first but supports the effort by state health officials.

"It's very important to involve the community," he said. "They are the people who are being affected. It is a huge task. It is not a simple task. We need to have a consensus. ... It should not be a unilateral decision."

PUBLIC CAMPAIGN

To that end, the Health Department plans a public education campaign that will begin next month to explain the project and get community opinions.

"We're responsible for making science-based decisions all the time," said Dr. Sarah Y. Park, state epidemiologist and chief of the Disease Outbreak Control Division. "Without neglecting the scientific basis for our state's pandemic planning, this project gives us a unique opportunity to focus on the values-based aspects of some of our decision-making. We encourage everyone to participate in the public activities and let their voice be heard."

Park is the principal investigator for Hawai'i's pandemic priorities grant.

Hawai'i's position as a gateway to and from Asia makes any potential pandemic of particular concern since air travel could quickly spread the disease. To guard against such problems, a disease surveillance and quarantine system was begun at Honolulu International Airport in 2005. It was the nation's first such system, and it screens sick passengers as they arrive for signs of serious illness.

Hawai'i and five other states have been chosen to participate in a federal program to carry out further pandemic planning.

The advisory group has found itself working on a subject with more variables than facts, such as when the Islands would be touched by a pandemic, or global disease outbreak.

"Is Hawai'i on the front end or the back end of an epidemic?" Gallo asked. "It's an important issue. If it was later in the epidemic, there could be enough vaccine to vaccinate everyone."

Even without a pandemic, deciding which flu strain to vaccinate against every year relies on estimates.

"The vaccine has to be reconfigured each year to accommodate the newly evolving strains," Gallo said. "It's very difficult to do. It requires a meeting of the minds about what kind of flu to expect for the next year. ... A pandemic would set the wheels in motion for getting the exact strain isolated and reproducing a new vaccine in large qualities. You would first need a portion of the actual germ or bug to produce the actual vaccine."

Members of the advisory group, such as Elizabeth Kent, director of the Center for Alternative Dispute Resolution, are focusing less on the science and more on the values that Hawai'i wants to protect during a pandemic.

"We want to be careful and considerate of everybody's rights," she said. "What we're talking about is the fabric of society and how you keep the fabric as intact as possible. You may have some special hobby that contributes so much to the fabric of our society or have a job that does. Trying to take all of that into account is very important. That part has been for me quite challenging, thinking about how to make those decisions."

FEDERAL GUIDELINES

In the event of a severe pandemic, federal guidelines from the U.S. Department of Health and Human Services and U.S. Department of Homeland Security recommend that the first people inoculated should be "deployed and mission critical personnel," public health workers, inpatient healthcare providers, outpatient and home health providers, first responders such as paramedics, firefighters and police, manufacturers of pandemic vaccine and antivirals, pregnant women and children under age 3.

But Hawai'i health officials want to solicit a broad variety of opinions to put together a list of people — or, more likely, job categories and demographic guidelines — of who should be inoculated first.

"It's a very interesting question: Who's going to get the vaccine in the event of shortages?" said Jason Seaborn, who is working on the project for the state Department of Health. "We're trying to elicit information from the public to see what values are specific to Hawai'i residents. As you work through each group, it raises questions such as, 'Should you vaccinate morgue workers? What are you going to do when the bodies start piling up?' "

In an e-mail, Seaborn wrote that the Health Department wants to "get feedback from Hawai'i's residents on what they value (i.e. — canoe carvers? Single moms? Elderly? Young? Teachers? Garbage collectors?)"

Gallo also sits on the advisory group and believes "it says a lot for the state of Hawai'i how serious they take this kind of planning and want to hear community input. They want to make sure their unique needs are heard in Washington."

But ultimately, the person who decides the priority list most likely will be Hawai'i's governor, Gallo said.

"Are we playing God?" asked Kent, a member of the advisory group. "No. Somebody else is going to make the hard decision. But we're trying to make a very hard decision that much easier in a thoughtful way."