The Challenge of the 2009 H1N1 Vaccine Supply
As of Wednesday, Oct. 21, 2009, a total of 14,070,900 2009 H1N1 doses were available for ordering by states. Of those available doses, 7,595,200 doses were injectable (flu shots) and 6,475,700 were LAIV (nasal spray vaccine). All states and the District of Columbia have placed orders for vaccine, and more orders are expected daily.
The vaccine situation changes rapidly, sometimes several times during one day. McKesson, the distributor for the 2009 H1N1 vaccine, is increasing the number of delivery sites from 90,000 to 150,000. Even as vaccine is shipped from the vaccine manufacturers to the McKesson distribution centers, orders are coming into McKesson, orders are being processed and shipped, and vaccine is arriving in thousands of locations across the country.
Initial doses of injectable 2009 H1N1 vaccine were shipped the week of Oct. 12, with additional doses scheduled for shipment each week. First doses of 2009 H1N1 vaccine were administered outside of the clinical trials on Monday, Oct. 5, 2009.
The 2009 H1N1 vaccination program has begun but initial supplies are small. More doses are expected for shipment each week. Members of the public who want to receive the vaccine have to be patient as the program expands and more vaccine becomes available. There will be enough vaccine available for anyone who wishes to receive it.
As has been demonstrated with seasonal influenza vaccine, working with a biologic is difficult and the vaccine development process is complex. Thus, forecasting how much vaccine will be available at a certain time is challenging and the amounts will vary from week to week. Millions of doses of vaccine are in the pipeline, and federal, state and local public health authorities are working to get vaccine out to the public as soon as it is received.
The CDC had to choose between waiting to distribute the vaccine until large quantities were ready to be shipped versus distributing limited quantities of the vaccine sooner. A decision was made for the latter option recognizing that while it would create some challenges and frustrations, it would allow people to be vaccinated against this disease as soon as possible.
Thus, the CDC only has small amounts of vaccine for states to order at the moment. Given this situation, states will initially be conducting very targeted vaccination efforts that take into consideration their local situation with 2009 H1N1 disease. It is also important to keep in mind that there will be lag times between states placing orders and vaccine actually being distributed and any number of things can create lag times between time of distribution to states and when vaccine actually arrives in provider offices or clinics.
This vaccine program is a massive and challenging undertaking and is being carried out at a time when state and local health departments have experienced severe budget cuts. There will likely be bumps along the way, but the CDC is optimistic the 2009 H1N1 vaccine will be available to all of those who need and want it.
The AMA will continue to monitor the 2009 H1N1 vaccine supply situation and provide updates as they are available.
Oct. 29, 2009