Flu vaccine stampede offers preview of pandemic
■ State health departments scrambled to connect those in need of a flu shot with dwindling supplies.
By Susan J. Landers — Posted Jan. 5, 2004
Washington -- There could be a silver lining to this season's widespread shortage of flu vaccine.
After the panic caused by last fall's severe and early flu outbreak, people may in future years place a higher priority on rolling up their sleeves for that annual pre-Thanksgiving shot, thus providing manufacturers a more predictable market and cutting down on the estimated 36,000 deaths attributed to the flu each year.
"We've tried to scare people for years to get them to get their flu shots. But they didn't respond until this year," said Richard Raymond, MD, chief medical officer for the Nebraska Health and Human Services System.
Nebraska, like many other states, was faced with a run on vaccine supplies when residents were frightened by reports of flu deaths of several children in neighboring Colorado. As the news traveled, resulting shortages prompted health officials in several locations to take creative steps to redistribute meager supplies so those at highest risk had a better chance of finding the vaccine.
Dr. Raymond used his state's Health Alert Network, which was developed using federal bioterrorism dollars, to collect information from physicians, pharmacists and others who still had vaccine.
The responses to the alert began at 8 a.m. on Dec. 8, 2003. By 5 p.m. that night, every local health department had faxed the total number of doses they had in their districts. "We were able to do something so that those people who called knew where to go to get flu vaccine," said Dr. Raymond. Ultimately, though, "all we did was help everybody run out by Wednesday rather than by Friday."
Kansas set up a toll-free phone line to do much the same thing, said state deputy epidemiologist Gail Hansen, DVM, MPH. Dr. Hansen was also hoping that vaccine manufacturers had held a supply in abeyance that could still be tapped by the states -- a scenario that came to pass on Dec. 11, 2003, when Health and Human Services Secretary Tommy Thompson announced that 250,000 doses of vaccine had been purchased from Aventis Pasteur.
Of the extra doses, 100,000 were adult vaccine and were quickly shipped to state health departments. The remaining 150,000 doses were pediatric. These supplies are expected to be shipped to states this month.
The vaccine in short supply was the inactivated version given via injection. Supplies of the live, inhaled vaccine were more readily available -- at least in mid-December.
The Centers for Disease Control and Prevention recommended that the inactivated vaccine be reserved for children and adults at the highest risk of serious complications from the flu and that the live vaccine be used by healthy people older than 5 and younger than 65.
Although several children have died in the current flu season, which got off to an early start in October, it's not yet clear whether the siege will ultimately prove to be more deadly than in other years, or the strain of virus more virulent than strains that have come before, said CDC Director Julie Gerberding, MD, MPH, during a Dec. 11, 2003, briefing.
"It's just too early in the course of the outbreak to say for sure how this will compare overall," she said. "But obviously the early start and the early widespread activity have given us a great deal of concern. And obviously it has concerned a lot of people and that's why there's been such an interest in getting the vaccination this year."
Meanwhile, the widespread vaccine shortage coupled with the vaccine's lengthy annual production schedule are increasing worries in the public health community that the nation is not prepared for a flu pandemic that some believe is inevitable and overdue.
While public health surveillance is better and antivirals that mitigate flu symptoms are available in limited amounts, the flu vaccine is still developed using technology from the 1940s and 1950s, said Greg Poland, MD, director of the Mayo Vaccine Research Group at Mayo Clinic's College of Medicine in Rochester, Minn.
"New technologies are in the works, but they have to be approved by the Food and Drug Administration," Dr. Poland said.
"In a pandemic phase it's likely that there's not going to be any vaccine," said Jonathan Temte, MD, PhD, associate professor of family medicine at the University of Wisconsin. In addition, the current supply of antivirals is not nearly enough to treat the number of people likely to be ill, he noted.
The Infectious Diseases Society of America, a group of 7,000 infectious diseases physicians and scientists, urged Secretary Thompson to begin work now on an international research strategy to ensure global access to a pandemic influenza vaccine.
While the United States has committed substantial resources toward research and control of several serious emerging infectious diseases and potential bioterrorism agents, the IDSA views pandemic influenza as representing a far greater threat to the United States and other countries. In an August letter to Thompson, the society recommended that greater attention be paid to reverse genetics -- a technique that more rapidly prepares strains of influenza viruses for use in vaccine production.
"The extraordinary importance of reverse genetics was demonstrated recently by the preparation of a candidate vaccine strain derived from an avian influenza virus isolated a few weeks earlier in Hong Kong," according to the letter.
Dr. Poland suggests a broadening of the vaccination policy as a way to ready the nation's health system for a pandemic.
"We have a big problem in this country," he said. "The public is fickle. In normal years they don't get the vaccine and we make 70 million doses of it and waste 12 million. Now all of a sudden it's a bad year and everybody's angry that they can't get the vaccine."
Dr. Poland would like to see the development of an influenza vaccination policy that includes everyone. "The reason being, if we can develop the infrastructure now to do it, pandemic planning becomes a lot easier."