Vaccine reallocation leaves doctors with tough choices

Physicians are having to prioritize their high-risk patients for flu shots, and some are using novel methods to stretch supplies.

By Victoria Stagg Elliott, AMNews staff. Nov. 22/29, 2004.

David L. Bramm, MD, a family physician in Huntsville, Ala., hasn't given his wife a flu shot, although he received one himself. His nurses all got the vaccine, but their healthy children didn't, in accordance with recommendations issued by the Centers for Disease Control and Prevention after one manufacturer experienced contamination problems affecting 46 million to 48 million doses.

These were the easier decisions to make when it came to doling out the 50 shots he shared with the three other physicians in his group practice. This flu shot tally is far short of the several hundred expected -- leaving the group with more high-risk patients than vaccine. The hard part has been to decide who among these patients should be at the front of the line.

"We targeted our supplies to employees and our sickest patients, and we don't have any left," he said.

Dr. Bramm is one of the many physicians across the country struggling with this year's unusual situation. After Chiron Corp.'s Oct. 5 announcement that it would not be shipping any vaccine for the 2004-05 flu season, the other two manufacturers ramped up their production. Still, the new total will be far below the nearly 100 million doses initially predicted.

Now, more than 58 million doses of injectable and 3 million nasal vaccines will be available this flu season. Aventis Pasteur has been shipping doses of the injectable vaccine to those identified as serving high-risk populations, in accordance with a reallocation plan worked out by the CDC, manufacturers and others. All of the first million doses of the nasal vaccine have been distributed, but another 2 million are expected in mid-November.