Distribution gaps appear in flu shot supply

More influenza vaccine will be manufactured this season than ever before, but public health officials are warning that this circumstance does not mean that everyone will have all that they need all at once.

"Given the number of manufacturing plants ... and the large number of doses currently being produced each year, it isn't possible to complete the production and distribution process prior to the vaccination season," said Jeanne Santoli, MD, MPH, deputy director of the Immunization Services Division in the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases. "This means that influenza vaccine distribution takes place in a phased fashion over a number of months."

Public health officials have been talking about this season's projected ample supplies with great anticipation. As many as 115 million doses are expected before the season is through. As of mid-October, about 40 million already had left manufacturers' hands -- making more doses available early this season than in prior years. Officials say prioritizing who gets vaccine first is not necessary. Manufacturers also are sending out partial shipments to make it more likely that those who provide immunizations receive some of their vaccine orders.

But as public health officials also predicted, distribution issues are making for a bumpy start to the process.

For instance, the American Academy of Pediatrics announced last month that there would be a delay in receiving Sanofi Pasteur's preservative-free shot intended for children. This holdup has made vaccination efforts particularly difficult for physicians who treat this age group because children who have never received a flu vaccine before must receive two doses a month apart.

"The delay is what makes me nervous," said Robert Steele, MD, a pediatrician at St. John's Children's Hospital in Springfield, Mo. "[About 115 million doses] doesn't generate a lot of enthusiasm for me. I need timing and doses." Dr. Steele is also chair of his state's childhood immunization committee and a board member of AAP's Missouri chapter.

For adults, public health officials caution that, although there will be plenty of vaccine, there will also be distribution gaps early in the season that are expected to disappear as supplies flood the market.

"With the large number of doses that we anticipate being shipped over the rest of this month and then in November, we feel that will really effectively smooth out the differences that we're seeing right now between providers," Dr. Santoli said.

But those involved in the process are recognizing that frustration with the distribution system is growing and are hoping that a better understanding of how it works will ease this response. Most notably, the Flu Vaccine Business Practices Initiative, launched this season by the Health Industry Distributors Assn. and firms involved in getting immunizations from the manufacturers to doctors, have launched the Web site Flu Supply News. It attempts to explain the intricacies involved in getting this product into physicians' hands.

"Manufacturing flu vaccine is extremely complex," said Matthew J. Rowan, HIDA's president and CEO. "The good news is, once distributors receive it, they send it to doctors within a few days."

Members of the initiative also have agreed to follow a code of business practices that includes complying with CDC guidelines and allocating resources to address grievances.

Vaccine experts also are taking steps to ensure that physicians know where to get vaccine throughout the season. The National Influenza Vaccine Summit, co-sponsored by the American Medical Association and the CDC, is establishing the Influenza Vaccine Availability Tracking System. This resource will share information about which distributors have flu immunizations for sale and how to contact them.