CDC drops high-risk priorities for flu shots

Doctors hope the move will mean an increase in vaccination rates, but experts warn that unless production technology improves, shortages and delays could happen again.

By Victoria Stagg Elliott, amednews staff. Sept. 15, 2003.

The flu likely will cause all the usual problems in upcoming months, but indications are that flu vaccine supplies, at least, will not.

Flu vaccine production has gone so well that the three manufacturers started shipping it out in July and August, as much as a month earlier than expected. Also in August, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices announced that the two-tiered vaccination system will be suspended. This approach was created for shortage years to focus early vaccine supplies on health care workers and those at high risk for flu-related complications and defer others until November.

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"The supply of influenza vaccine makes it possible for the CDC to drop the tiered immunization schedule this season and will allow everyone to begin to seek influenza vaccination in October," said Phil Hosbach, vice president, new products and immunization policy at Aventis Pasteur, one of three vaccine suppliers.

Doctors cheered.

"I'm tickled to death," said Mark Ivey Jr., MD, a family physician in Payson, Ariz. "For us to be able to have an adequate supply and give it to all the patients is a tremendous advancement."

The vaccine supply was plentiful and stable last year with more than 95 million doses manufactured. But demand was flat. This year, though, the CDC is expecting more than 85 million doses, including 4 million doses of FluMist, a nasal version manufactured by MedImmune Inc. and co-marketed by Wyeth Vaccines, which left the injectible market last year.

4 million doses of a nasal flu vaccine will be available for the 2003-04 flu season.

And this year's supplies are running on time. So even though fewer doses are now in the pipeline, experts are optimistic that the flu vaccine will reach more people than in previous years.

The CDC's decision to suspend the tiered system is in part a response to suggestions from some members of the annual National Influenza Vaccine Summit sponsored by the AMA and the CDC. Specifically, many physicians maintained that in times of plenty, the tiered approach was actually interfering with getting the most people vaccinated.

"This change allows everyone, private health care providers and community immunization providers, to offer vaccine when the community demand is greatest," said Steve Allred, general manager of Getaflushot.com, which sets up large-scale adult vaccination clinics in grocery stores, workplaces and senior centers in Oregon and Washington state.

There were more doses last year than ever before, but millions of doses remained unused at every level of distribution from the manufacturer down to the doctor. Patients were sometimes turned away or discouraged early in the season and never returned, and physicians and others who abided by the system were undercut by those who didn't.

Though the concept was somewhat effective, most agree it was far from perfect.

"It was harmful, because if you tell someone to postpone getting a flu shot, they may never come back, and they get the wrong message that, for you, it's not important." said William Schaffner, MD, a board member of the National Foundation for Infectious Diseases and chair of preventive medicine at Vanderbilt University School of Medicine in Nashville.

But while everyone is pleased by the news that this season could be smooth sailing, experts warn that the flu vaccine manufacturing process and the nature of the vaccine make it very susceptible to a future season disrupted by delays and shortages. The tiered system may have to return.

"Each year, the development of influenza vaccine is a technological miracle and a race against the deadline," Dr. Schaffner said. "There's always the possibility of a glitch. We're not out of the woods by any means."