Flu shot demand likely to increase next fall

David Reed, MD, a family physician in Wray, Colo., population 2,000, will be ordering 1,500 doses of flu vaccine for next season. Usually, he orders around a thousand, but he is convinced that next year he will not be stuck with leftovers -- mainly because he expects his patients to remember this year's brutal flu season. And if they don't, he will give them a gentle nudge.

"We don't want to run out like we did this year, and I think we'll use it," he said. "We'll just encourage people to get it."

Dr. Reed is not alone. Many doctors around the country say they and their patients have an increased interest in the flu shot despite signs that this season's vaccine may not have been as effective as in most years, according to a paper in the Jan. 16 issue of Morbidity and Mortality Weekly Report.

Each year, the flu virus strains selected for inclusion in the vaccine are chosen by the Food and Drug Administration in March in conjunction with the Centers for Disease Control and Prevention and the World Health Organization. The selection is based on a combination of known variants in circulation and the feasibility of culturing these strains. As a result, the mix is sometimes just a bit off.

"The problem is we're using fairly old technology and you need a lot of lead time," said Walter Orenstein, MD, special adviser to the director of the CDC's National Immunization Program. About this year's experience: "While there was some suggestion that Fujian [strain] was emerging, there was concern that companies would not be able to make a vaccine in time."

Nonetheless, most agree the shot was still worth getting. Most also dismiss concerns that this year's lower efficacy will undermine future vaccination rates. This flu season, which hit early and hard and prompted widespread media coverage of related deaths, could actually lead to increased patient interest in the flu shot.

"They were so anxious this season, and that memory is what's going to drive demand next season," said Ephraim Back, MD, chief of family practice at St. Clare's Hospital in Schenectady, N.Y.

Also, for many physicians, the MMWR study doesn't reflect their day-to-day experiences.

"During the peak, most of the people who came in with influenza-like illness had not been vaccinated," said Dr. Back. "You could count on one hand the people who had been vaccinated and presented with influenza-like illness."

Ultimately, this year's mad rush for the vaccine, challenges in meeting patient demand and questions about vaccine efficacy have fueled interest in adding more structure to the flu vaccine development system.

"This is a clarion call to government agencies as well as organized medicine," said Michael Greene, MD, president of the Medical Assn. of Georgia. "We need to come up with a plan."

But for those in public health who have long been working on their own strategies to stabilize and eventually increase the supply, this is the year that the profile of the flu has been taken to a new level.

"A face has been put on influenza, particularly in children," Dr. Orenstein said. "Influenza has in the past been numbers and statistics. This year, the media came up with real people with real serious complications. Our hope is that will translate in future years to increase vaccine uptake."