Flu vaccine experience leaves physicians watchful, worried

Though physicians still consider the vaccine to have significant value, some are becoming more hesitant about administering it.

By — Posted Aug. 22, 2005

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The hard-luck experiences of recent influenza seasons have led physicians to view the upcoming months of coughs, colds and flu shots with both glass-half-full and glass-half-empty attitudes. But vaccine experts are paying close attention to how these feelings translate into ordering and vaccination trends, because they believe it could foreshadow future public health challenges.

According to unpublished data from a survey of 1,200 physicians carried out by University of Colorado Health Sciences Center and funded by the Centers for Disease Control and Prevention, 98% of physicians plan to administer the flu vaccine this season, with an estimated 38% to 51% ordering more doses than last year. A complete analysis of the University of Colorado data is expected to be published later this year.

AMNews, however, conducted a small, unscientific poll of its own to gain insight into what has become a complicated picture. Forty-five family physicians and internists from 27 states responded. All are active in the American Medical Association, the American College of Physicians or the American Academy of Family Physicians, and their work situations range from solo practice to large multispecialty groups.

Overall, most said they had significant problems last year because of Chiron Corp.'s abrupt exit from the market when plant contamination problems triggered a loss of nearly half of the expected U.S. supply. This episode, which came on the tail of other difficult seasons, appears to have changed how some feel about their role in administering the vaccine.

All still consider it important for patients, but many doctors are angry about a distribution system they perceive as putting physicians last. Price increases, too, make it less economically viable for them to administer -- especially when unused vaccine often can't be returned and there seem to be no guarantees that all of it will be used.

"The system has failed," said Arthur Gale, MD, an internist in St. Louis who has ordered 2,000 doses for the past three seasons but did not get any last year. Such perceptions have led some doctors to reduce their orders or get out of the business entirely, which means patients might not be able to get the vaccine from their physicians -- a source public health officials say is critical to achieving vaccination coverage targets.

"Physicians do a great job of reaching the risk groups," said Jeanne Santoli, MD, MPH, deputy director of the Immunization Services Division at the CDC's National Immunization Program. "We have been very concerned about how [recent problems] will impact physicians."

Counting shots

Of the 45 physicians who participated in the AMNews poll, 36 had problems last year getting the vaccine they ordered in a timely manner. Most who didn't have any problems now plan to order more vaccine for the approaching season; a handful of this group are ordering the same.

"[We] increased our order ... to meet patient demand," said Mary Carpenter, MD, a family physician in Winner, S.D., who upped her order from 1,400 to 1,520 doses. She received all of her order last season, though some was redistributed to doctors who weren't so lucky. "I was very impressed with how our state health department and the providers worked together to get the most high-risk patients vaccinated immediately."

For those who did face difficulties during the 2004-05 season, the story is slightly more intricate. Only 10 out of these 36 physicians so far have decided to order more vaccine this time. A handful of them are doing so because they don't expect to get all they ordered, but most also are anticipating more patient interest.

"The shortage increased patients' awareness of flu shots, and their demand for the immunization increased," said Mary Newman, MD, a Baltimore internist who has increased her order from 3,850 to 3,960 doses. She received less than a third of what she ordered last time around.

Fifteen of these 36 doctors said they were ordering the same amount, although this is in part due to the fact that Sanofi Pasteur, the only company confirmed as an approved vaccine provider in 2005-06, placed limits on pre-booked orders.

"We would have ordered more," said Harold Ishler, MD, a family physician at a large multispecialty clinic in Baton Rouge, La. His facility had significant difficulties last year getting all of the 70,000 doses that were ordered. "We are hoping that most of our patients will be able to get the vaccine either from us or other places despite not being able to order what we wanted."

According to Sanofi spokesman Len Lavenda, this mechanism was used to increase the number of physicians and other vaccine providers who could place pre-bookings. The company also wants to ensure that the vaccine is available to long-term-care providers.

Most alarming to public health officials are the doctors who are reducing their orders or giving up completely. Of those who had problems last year, eight out of 36 are cutting their order, and three are getting out of the business altogether. Three more of these physicians are seriously considering dropping out in the future.

"I have ordered 750 doses of influenza vaccine this year because I believe my patients should be immunized. Paying for this order will mean that I probably will not be able to take home any salary in October," said Lawrence M. Markman, MD, a family physician in Wilmington, Del. "This may be the last year that I am willing to play this game."

But in addition to the flu vaccine fatigue and frustration, there also is significant doubt that this year will be better. A quarter of those who had problems last year are bracing for a repeat in which they don't receive all of what they ordered or it arrives too tardy to be useful.

"We need 1,000 doses, but we're not really expecting it all," said Charles Cutler, MD, an internist in Norristown, Pa., who increased his order from 900 doses to 1,000. "Last year we couldn't get vaccine at all for three-quarters of the season, and then we were flooded at the end of November and mid-December. We could get as much as we wanted. I hope we get it earlier this year."

The uncertainty is echoed by public health and medical society officials, because the situation is more in play than ever.

Sanofi is expected to provide at least 50 million doses of the injectable vaccine, and Medimmune plans to produce 3 million doses of the nasal version. GlaxoSmithKline may provide 10 million injectable doses. At press time, though, their contribution was still dependent on regulatory approval.

Chiron is also a wild card. Company statements said it expects to provide 18 million to 26 million doses.

"I can understand physicians' frustration with the instability of the flu vaccine supply," said AMA Trustee Ronald M. Davis, MD. The AMA long has worked on flu vaccine supply issues and co-sponsors an annual summit on the issue with the CDC. "I am as hopeful as anyone would be that the orders will be fulfilled."

Back to top


Coping strategies

  • 98% of surveyed physicians plan to offer influenza vaccine to patients.
  • 50% plan to place their orders earlier in the season.
  • 38% to 51% plan to order more vaccine this year.

Source: University of Colorado Health Sciences Center survey, funded by the Centers for Disease Control and Prevention

Back to top

Wait until next year

AMNews questioned 45 family physicians and internists active in the American Medical Association, American Academy of Family Physicians or the American College of Physicians about last year's experience with the influenza vaccine and the upcoming season.

20% said they received all they ordered last year. Of this group:
78% are ordering more for the upcoming season.
22% are ordering the same amount.

80% did not receive all of last year's order. Of this group:
28% are ordering more.
22% are reducing the size of their order.
42% are holding steady.
8% are phasing the flu shot out of their practices.

Source: AMNews reporting

Back to top

External links

National Influenza Vaccine Summit, co-sponsored by the American Medical Association and the Centers for Disease Control and Prevention (link)

CDC influenza data and resources (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn