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Flu Vaccine Late This Year
By Nicole Montesano, News-Register
October 25, 2005
Public health departments are competing head-to-head with private providers for scarce flu vaccine this year and often coming out on the short end.
That has forced many of the departments to delay the start of their annual winter vaccination programs and/or limit the number and frequency of the clinics they offer.
The squeeze is being felt most keenly by the frail elderly and other high-risk patients, who are supposed to get first shot at vaccine by order of the federal Centers for Disease Control and Prevention.
The CDC limited vaccine to high-risk patients through the month of October. However, many public health departments, including Yamhill County's, were not able to get vaccine in time to offer any October clinics.
The county's first clinic of the season is set for Tuesday, Nov. 1. And due to the late timing, that clinic and those to follow will be open to all-comers, not just to local residents judged to face the greatest need.
The county typically begins sponsoring clinics at the beginning of October. Unable to get vaccine, however, it has missed the entire high-risk-only period this year.
The government's sickest-first policy "is just not working out as had been planned," said Patrick Libbey of the National Association of County & City Health Officials.
He said a national survey of 120 health departments showed all but six experiencing delays. Even those able to get vaccine were often having to settle for partial shipments, leaving them short, he said.
Local public health manager Nancy Nunley said the problem is a system in which manufacturers are supplying providers on a first-come, first-served basis, without regard to public policy considerations.
There are alternatives, of course, but they are often less than ideal. When it comes to private providers, older residents complain, information is scanty, clinics scarce and lines long.
Some doctor's offices continue to offer flu vaccine, but they are facing the same kind of supply problems as public health agencies. Given supply problems and longstanding unhappiness over inadequate Medicare reimbursement rates, many doctors have simply gotten out of the flu vaccination business, leaving it to health departments and private pharmacies to fill the gap.
That's not always a good option for high-risk patients anyway, as relying on a doctor means scheduling an appointment and making the arrangements necessary to meet it.
Freestanding and grocery store pharmacies often schedule clinics through private providers, but those clinics are usually of only one day's duration and not always well-publicized. What's more, it can mean standing in long lines - something high-risk residents aren't always up to.
McMinnville resident Virginia Hepburn, 77, is the caretaker for an 83-year-old friend whose health simply won't permit that. With doctors unable or unwilling to meet their needs, she faces a major barrier in getting herself and her friend vaccinated, she said.
Across the country, elderly patients are "surprised and frustrated and annoyed that they have to search it out and can't get it at their doctor's office," said Dr. Ruth Kevess-Cohen, a geriatric specialist in Silver Spring, Md. And she said inadequate Medicare reimbursement is only part of the problem.
Kevess-Cohen said her office ordered 1,400 doses from two different suppliers. But she said neither one can yet say if and when she will get her first shipment.
If shipments arrive too late in the season, the vaccine may go to waste. And that means taking yet another financial hit for the physician, she said.
"We never used to have this problem," Kevess-Cohen said. The CDC should "perhaps require that doctors' offices have as high a priority as grocery stores."
McMinnville resident Pat Myers said she doesn't understand why physicians and health departments don't simply place their orders earlier.
But Kevess-Cohen placed her order back in February - nine months ago. That begs the question, how early is early enough?
Only four companies are licensed to distribute flu vaccine in the United States. That can lead to shortages if any one of them experiences a disruption in production - something that occurred in a major way last year, when regulators in Britain shut down production at Chiron Corp. over contamination issues.
According to the CDC, there should be plenty of vaccine this year. It's just arriving late, something the agency plans to look into.
The agency said that's partly just fallout from last year's problems, as Chiron was slow to get production going again following the government-ordered shutdown. Efforts to protect public safety led to intense scrutiny, slowing resumption of full production, the CDC said.
Locally, providers are typically still waiting on orders placed with Chiron. And they are typically getting only partial shipments from the world's largest vaccine producer, Sanofi Pasteur.
In their defense, manufacturers say each year's vaccine must be custom-tailored, and that takes time. They say it is a slow, exacting process, as is the manufacturing itself.
Yamhill County Public Health has been vaccinating residents of some local nursing homes and residential care facilities. But it did not have enough supply to stage its usual round of October clinics.
Spokeswoman Sarah Bates said the department typically provides about one third of all local vaccinations - about three times the national rate for public health agencies. So the supply problems it has been experiencing hurt.
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