CDC official offers insights on the flu vaccine shortage

Raymond Strikas, MD, CDC's associate director for adult immunization, discusses the reallocation plan and what can be done to stabilize future supplies.

By Victoria Stagg Elliott, amednews staff. Jan. 3/10, 2005.

When Chiron Corp., one of the United States' two injectable flu vaccine suppliers, announced that it would not be able to provide any shots for the 2004-05 season, public health officials were left to figure out how to get remaining supplies to those who needed it most.

The situation was further complicated by the fact that more than half of the 55 million doses expected from Aventis Pasteur had already been distributed.

Raymond Strikas, MD
High priority
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Since then, the public health response has moved forward. Aventis agreed to ramp up production, increasing the number of shots expected to be available this season to at least 58 million. Millions more doses may be imported. MedImmune Inc. almost tripled production of the nasal vaccine to 3 million. Additionally, at press time, the CDC's Advisory Committee on Immunization Practices issued updated recommendations effective Jan. 3 to expand the priority groups in areas that have sufficient vaccine supply.

Raymond Strikas, MD, associate director for adult immunization at the CDC's National Immunization Program and the agency's lead person on influenza vaccination issues, discussed with AMNews this year's unique flu vaccine challenges.

Question: What was your initial reaction when you found out that Chiron would not be able to fulfill its promised shipments?

Answer: We had a lot of concern about how we were going to manage this shortfall. We've never had to work with industry, public health and our other partners on this scale. We fortunately had partnerships with all the players, including folks at the AMA.

Nasal flu vaccine production reached 3 million doses for the 2004-05 season.

Q: When you say you had to work in ways that you hadn't done before, what do you mean?

A: We had to ration a scarce resource. It's not something we've done.

We're used to making recommendations on how to use medical products and services. This is not because they're in scarce supply, but because they need to be targeted to be most effective.

Q: How was the decision made regarding who gets the vaccine when?

A: The ACIP met with CDC staff to winnow down the usual 185 million people recommended to receive the vaccine to eight priority groups or about 98 million people.

Then we talked to Aventis and MedImmune about their vaccine supply. Aventis had shipped 33 million doses out the door. It was decided that it would be too difficult to bring those doses back for redistribution. It would be simpler to broadly disseminate the message about the priority groups for vaccine and work with the remaining vaccine, which ultimately turned out to be about 25 million doses.

We worked with MedImmune on the supply of the live FluMist vaccine and found that they could make an additional two million doses.

Q: What would you like to improve about the redistribution?

A: We need to figure out better how to quickly assess unmet needs. This is still difficult to do in an almost entirely private-sector distribution scheme where the vaccine companies sell vaccine where they wish, and it's distributed in a variety of ways.

Q: Physicians praised the reallocation plan but complained that they had problems finding out how much vaccine they would get and when. Is there any way to address this difficulty?

A: The chains of vaccine distribution and communication were long and complex, and I appreciate that it's been difficult for end users to receive the information, including many doctors. That's something to work on.

Q: What will it take to make the flu vaccine supply more stable?

A: Additional manufacturers and additional technology to offer more options on how this vaccine is made. Also, if there's more demand for the product, companies will find a way to make more, so we must work to develop that demand to match supply.

Q: Some areas of the country opted [before ACIP announced its decision to expand high-priority categories] to go beyond the recommendation that only people in this year's high-risk groups receive the shot. Is this appropriate?

A: The CDC and ACIP make recommendations. These don't have the force of law.

Each state has the prerogative to do what it deems appropriate.

However, we are aware of locations that need vaccine for their priority populations. We hope that the states who have will share with the have-nots as much as possible.

Q: What are your hopes for next season?

A: Lots of flu vaccine available for all who want it, and lots of people who want it.

ADDITIONAL INFORMATION:

Raymond Strikas, MD

Born: 1953.

Medical education: University of Illinois College of Medicine, Chicago.

Current position: Associate director for adult immunization, Centers for Disease Control and Prevention's National Immunization Program (since March 2004).

Professional history: Moved to Atlanta in 1983 to work with the CDC's Epidemic Intelligence Service and, except for a four-year stint at the Atlanta Veterans Hospital (1985 to 1989), has worked for the CDC ever since, focusing primarily on adult immunization issues.

Major accomplishments: Assisted in gaining Medicare coverage for influenza vaccination; published recommendations for health worker immunizations and helped implement routine reporting of adult immunization coverage rates.

High priority

The Centers for Disease Control and Prevention has expanded its priority groups for inactivated influenza vaccination.

The updated recommendation, effective Jan. 3, adds the following categories, dependent on the availability of vaccine in state or local health jurisdictions:

Adults 50 to 64.
Close contacts of people in high-risk groups.

Additional expansion effective Dec. 17, 2004, under Vaccines for Children:

Influenza vaccine can be given to VFC-eligible children who are household contacts of people in high-risk groups.

Existing categories of people at high risk for influenza complications developed in response to this season's vaccine shortage:

Children 6 months to 23 months.
Adults 65 years or older.
Anyone ages 2 to 64 with underlying chronic medical conditions.
Women who will be pregnant during flu season.
Residents of nursing homes and long-term-care facilities.
Children ages 6 months to 18 years who are on chronic aspirin therapy.
Health care workers involved in direct patient care.
Out-of-home caregivers and household contacts of children younger than 6 months.

Source: CDC Advisory Committee on Immunization Practices, Dec. 17, 2004