Influenza vaccine: Delay injects a dose of reality

Production problems for this year's influenza vaccine provide a lesson about the vulnerabilities in a system that many take for granted.

Editorial. Nov. 27, 2000.

Last year about this time, government health officials were warning the public not to hoard medicine in fear of shortages -- that never did come about -- due to the year 2000 computer changeover. This year, officials have been facing the real thing, a major production delay of the influenza vaccine that tens of millions of Americans expect as a given every winter.

The shortfall is expected to be relatively short-lived -- production is expected to meet overall flu-season demand of about 75 million doses by next month -- but spot shortages of the flu vaccine continue for now. It has been a threatening situation for high-risk patients who rely on the vaccine to protect them from serious harm, and a frustrating one for physicians who have faced a stone wall in attempts to find vaccine for their patients.

Among the most disturbing aspects of the production delays are allegations of price gouging. Vials of vaccine are reportedly selling for as much as $150, five times the regular price.

Price gouging is the most outrageous reflection of what has been revealed to be an out-of-whack marketplace distribution system that did not prioritize deliveries by need, even though shipment delays have been anticipated since the summer. Another example -- less sinister, but still providing plenty of reason to give pause -- has been large-scale inoculations of healthy individuals at stores and in offices -- in normal circumstances it's an acceptable public health approach -- while those in high-risk groups are forced to wait. (For the curious, the AMA's own staff inoculations are on hold for now.)

Guidelines from the Centers for Disease Control and Prevention, strongly supported by the AMA, call for the prioritization of immunizations to those in high-risk groups -- including those older than 65, adults and children with chronic medical conditions, patients in nursing homes and chronic care facilities and pregnant women in the second or third trimester -- until the shortages end. For more information, visit the AMA flu vaccine Web site (http://www.ama-assn.org/ama/pub/physician-resources/medical-science/vaccination-resources/adult-vaccination/influenza-vaccine-updates.shtml).

In a welcome move, the CDC is underwriting production of 9 million new doses of the vaccine for high-risk patients. The CDC has also established a local flu vaccine exchange program so that those with a supply of the vaccine can route it to high-risk patients.

With luck, these measures will bring this situation to a good end. But what has happened this year should not be forgotten, and contingency plans must be prepared for any replay.

In contrast to the Y2K worries that spurred those unfounded fears of a medicine shortage a year ago -- recall that there was supposed to be a worldwide computer meltdown -- the vaccine delay was rooted in less dramatic but inherent vulnerabilities in a vaccine production system that many take for granted. Manufacturing problems combined with a particularly slow-growing strain of flu virus caused this year's delay.

Influenza typically claims 20,000 lives a year and accounts for more than 100,000 hospitalizations. Both figures largely represent individuals older than 65 or in other high-risk groups. For them, and millions more who simply want to be spared a few miserable days of flu, the vaccine is a medical miracle -- preventive medicine that is cheap, highly effective and virtually always safe.

But as the current shortage well shows, what's in the glass vial is really only half the miracle. Access to it -- and this applies in the larger sense to all of the wonders that medicine has to offer -- is the essential other half.