For flu vaccine shortage, CDC priorities apply

Ethics Forum. Dec. 5, 2005.

How should doctors ration limited supplies of influenza shots?

What ethical considerations do you, as a family physician, consider when deciding whom to vaccinate?

Reply:

Influenza is a potentially lethal infection that can spread rapidly from person to person. With the exception of recent concerns about an impending avian flu pandemic, the public and most health care professionals have become largely complacent about the flu's potential health and societal impacts. There were three worldwide influenza pandemics in the 20th century, the most deadly of which in 1918 claimed the lives of millions. Many of the 1918 victims were young and healthy before infection; nevertheless, death often occurred within days of the initial symptoms.

Today, annual influenza vaccination is an effective means for controlling the spread of the virus. There are now two forms of influenza vaccine: deactivated, which has been used for many years and is administered by intramuscular injection, and live attenuated influenza vaccine (LAIV), which is administered nasally.

Influenza vaccine distribution delays or supply shortages have occurred in the United States in three of the last five influenza seasons. Last year the nation experienced a major shortage that left many physicians with limited or no doses. Last year's shortage highlighted communication and preparedness problems in the U.S. public health system. Local public health authorities found themselves without vaccine. In a display of distribution inefficiency, large business vendors had the vaccine when hospitals and doctors did not; low-risk patients were being vaccinated while high-risk patients went without; and the elderly and infirm had to stand in line for hours. Federal, state and local health authorities have worked hard to correct these deficiencies.