The flu vaccine shortage: Patience and teamwork are virtues

The flu season may just be starting, but already it has been a strange, strange year. Initially, the Centers for Disease Control and Prevention had high hopes for the 2004-05 influenza vaccination effort. Health officials were expecting about 100 million doses of vaccine. They also predicted that, after last year's flu hit hard and early, public interest and awareness would be high.

But on Oct. 5, everything changed. British authorities stopped vaccine manufacturer Chiron from shipping supplies because of production sterility problems. This created a deficit of nearly half of the vaccine ordered in the United States and left patients -- especially those at high risk of flu complications -- frightened by their vulnerability. Physicians were scrambling to try to meet their needs.

The CDC reacted quickly by creating updated guidelines directing doctors and other vaccine givers to direct the limited resource to only the highest risk groups. In the weeks since, the agency also has developed a reallocation plan to address supply gaps across the country and ensure that those who need it most get vaccinated.

The good news is that these efforts have been marked by unprecedented cooperation among physicians, other vaccine providers, public health departments, vaccine manufacturers, and even patients.

When the news initially broke, for instance, the AMA responded by reinforcing the CDC's updated recommendations. The Association also brought its communication resources to bear to help physicians gain access to needed information as quickly as possible through its leadership in the National Influenza Vaccine Summit.

While doctors are doing their best with this difficult situation, the message now is to keep expectations realistic.

Overall, there have been a total of 58 million doses in play, of which about 30 million were shipped by Aventis Pasteur before Oct. 5. Some of the remaining doses have been distributed to specific entities, such as hospitals and long-term-care facilities, which had ordered from Aventis.

In early November, the CDC entered the next phase of its reallocation plan, with an emphasis on getting vaccine to those facilities that had ordered from Chiron and serve high-risk patients -- such as long-term care and Dept. of Veterans Affairs facilities as well as Vaccine for Children program participants. Remaining vaccine also will be distributed to physicians and other vaccine providers who serve high-risk patients and had been Chiron customers.

The CDC has used a variety of mechanisms to identify where doses should be directed. First, manufacturers and distributors have made available to state and local health officials proprietary information regarding vaccine orders. These data allow health officials to identify who has ordered from Aventis or has unfilled orders from Chiron and reallocate as best they can. Second, a survey is ongoing with long-term-care facilities to ascertain their needs and assure vaccine distribution. Third, local health departments are conducting phone surveys of vaccine providers to spot gaps. Finally, a purchase tracking system is being used to track vaccine supply across the country.

Thus, the scarce resource has been targeted.

Physicians who initially ordered from Chiron and have not yet received any vaccine should contact their state health departments, identify themselves as doctors caring for high-risk patients and communicate as accurately as possible the amount of vaccine they need.

Another broader marching order is to stay focused. Physicians with patients who fall into the high-risk groups may still receive needed vaccine, but it will take time.

Patience and persistence are the buzzwords. This approach is especially true when dealing with otherwise healthy patients who have heard news reports that more vaccine has become available. To them, the message on high risk must be constant.

Physicians should use as a guide in communicating with patients the Advisory Committee on Immunization Practices' interim guidelines, which target the following groups for vaccination: children ages 6 to 23 months; adults 65 years and older; anyone with underlying chronic medical conditions; all women who will be pregnant during influenza season; residents of nursing homes and long-term-care facilities; children 6 months to 18 years who are on chronic aspirin therapy; health care workers with direct patient care; and out-of-home caregivers and household contacts of children younger than 6 months.

For those outside these categories, a doctor's best advice is good old prevention. Wash your hands frequently. Cover your cough. Avoid touching hands to the face.

Indeed, it's been an unusual flu season so far. But also one marked by a great deal of teamwork. Physicians have been a key part of this accomplishment and their continued efforts will guarantee that the limited vaccine is used wisely.