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The federal government has released its list of who should be first in line to get the H1N1 flu vaccine when it's ready because they are considered most vulnerable to the virus.

Dr. David Butler-Jones, Canada's chief public health officer, announced Wednesday that the list of who would benefit most from immunization includes:

• those under age 65 with a chronic illness
• pregnant women
• children 6 months to 5 years
• people living in remote communities
• health care workers
• those who care for infants or people with health problems

"These groups are not listed in priority sequences," Butler-Jones said as he made the announcement.

"Provinces and territories will use the guidance for planning purposes and will interpret it based on local circumstances and realities. Each of these groups is important."

The document also identifies others who would benefit from immunization:

• children 5 to 18 years of age
• first responders (e.g. police and firefighters)
• poultry and swine workers
• adults 19 to 64 years of age
• adults aged 65 years of age or over.

Vaccinations are expected to get underway in November. That's weeks behind the United States, which is is planning to start inoculations in October. Countries in Europe will start later this month.

It's also weeks behind the infection peak that some have said could occur as early as mid-October. An article by American researchers published last week in the journal Science warned the virus will have a high infection rate quickly during the second wave in North America but then peter out just as quickly as the fall continues.

Canada's vaccine priority list mirrors recommendations made by the World Health Organization and are similar to those ussed weeks ago by the U.S. government.

Officials say there will be enough vaccine for all Canadians, even after all the priority groups receive the shot.

Butler-Jones urged everyone to get the vaccine, noting: "the one clear way that we can stop a pandemic is for everyone to be immunized."

But surveys suggest Canadians have mixed feelings. A Canadian Press Harris-Decima poll released earlier this month found that only about 45 per cent of respondents intended to get the pandemic vaccine; an equal percentage said they would not.

Butler-Jones has said that PHAC plans to launch a communications campaign aimed at arming people with science so they aren't making their decisions based on misinformation and rumours.

Death rate appears lower than first estimated

Also Wednesday, an expert in infectious diseases told a meeting of flu experts with the U.S. Institute of Medicine that the death rate from swine flu is likely lower than earlier estimates.

Dr Marc Lipsitch of Harvard University said the death is probably no higher than a moderate year of seasonal flu.

"It's mildest in kids. That's one of the really good pieces of news in this pandemic," Lipsitch told the IOM meeting.

Seasonal flu has a death rate of less than 0.1 per cent. In Canada, PHAC estimates the flu results in an average of 20,000 hospitalizations and 4,000 deaths each year.

Lipsitch says this pandemic rates low on the U.S. government's own Pandemic Severity Index. That index has five categories, with a category 1 being comparable to a seasonal flu epidemic and a category 5 being comparable to the 1918 flu pandemic, which had an estimated death rate of two per cent or more.

Lipsitch estimates swine flu mortality ranges from 0.007 per cent to 0.045 per cent.

He took information from around the world on how many people had reported they had influenza-like illness (which is not always influenza), as well as government reports of hospitalizations and confirmed deaths.

Part of the reason that the death rate is low is that this flu is attacking younger adults, not seniors, as seasonal flu does. Young people are not dying of the flu at the same rate as the elderly do in seasonal flu, Lipsitch said.

"The news is certainly better than it was in May and even better than it was at the beginning of August," Lipsitch said.

Lipsitch conceded there had been panic about this virus in the early days, when a dearth of information made the epidemics in various countries look worse than they actually were.

"Yes, there's been hype, but I don't think it's been an outrageous amount of hype," Lipsitch said.