Last year's flu data offer insights for coming season

Better communication is recommended to help eliminate distribution problems as the vaccine makes its way from manufacturers' plants to patients' arms.

By Susan J. Landers, amednews staff. July 17, 2006.

Washington -- Physicians, vaccine distributors and manufacturers participate in an intricate dance each flu season, but the steps aren't always well understood. A look at the data from last year's influenza season reveals the root of some of the confusion.

Bottom line: even though the problems that plagued the system seemed to lie with distribution, the supply side was actually at fault.

Where did it go?
AMA adopts flu vaccine policy
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The major hiccup, of course, was that manufacturer Chiron, now part of the drug firm Novartis, did not deliver all of its promised doses and the orders it did fulfill arrived later in the season than physicians expected.

Ultimately, this circumstance appears to have had disproportionate impact among physicians.

Specifically, data that were collected at the January National Influenza Vaccine Summit, an initiative co-sponsored by the AMA and the Centers for Disease Control and Prevention, revealed that while 39% of the total supply of vaccine went to physicians last season, 80% of physicians' orders were placed through distributors rather than manufacturers.

Since Chiron, one of only two major sources of injectible vaccine last season, sold entirely through distributors, all fits and starts in their plant's production process were clearly felt in physicians' offices.

The data were analyzed by the Health Industry Distributors Assn. and published as a market brief titled "2006 Influenza Vaccine Production and Distribution."

Smoothing out the bumps

Players in the vaccine business counsel improved communication between all parties as a step toward overcoming some of the scheduling difficulties that have roiled previous seasons. This approach is supported by the AMA and the HIDA.

For instance, distributor FFF Enterprises, based in Temecula, Calif., is taking a step toward clarifying delivery dates with its new Web-based system for ordering vaccine.

Physicians also will be allowed to secure a date, if that date is still available, thus taking some of the uncertainty out of when to notify patients that they should come to the office.

More information on the influenza vaccine ordering system is available online (www.myfluvaccine.com).

The AMA also advises physicians to spread their orders among the various sources, which this year include Sanofi, Novartis, GlaxoSmithKline and MedImmune.

As of late June, physicians could still prebook vaccine from Glaxo, Novartis and MedImmune.

ADDITIONAL INFORMATION:

Where did it go?

The distribution of last season's supply:

Vaccine supply	Distributors' supplies
39% Physicians 25% Public sector 14% Long-term-care, medical centers, pharmacies and other distributors 9% Acute care facilities 7% Retail corporations 6% Other 100%	80% Physicians 10% Long-term care-facilities 5% Pharmacies and other distributors 5% Acute care facilities 100%

Source: 2006 Centers for Disease Control and Prevention/AMA Flu Summit presentations; 2006 Health Industry Distributors Assn. member survey

AMA adopts flu vaccine policy

Chicago -- In reaction to the growing ire from physicians over the perception that retail outlets have influenza vaccine when they have none, the American Medical Association intends to ask manufacturers to sell directly to doctors enough doses to vaccinate high-priority patients.

The AMA also wants both manufacturers and distributors to create dedicated systems for small- and medium-sized medical practices to preorder vaccine, according to policy passed at its Annual Meeting last month.

"We believe that there should be a consistent policy for tiered distribution of influenza vaccine on a priority basis for patients that need it and not a market-driven philosophy whereby the big box stores and national pharmacy chains get it first," said Stuart Cohen, MD, a delegate for the American Academy of Pediatrics.

Some delegates cautioned, though, against recommendations that might translate into restricting supplies, particularly in light of the fact that there could be ample doses in the upcoming season.

"While prioritizing physicians may be appropriate during times of vaccine shortage, it may not be appropriate during times of adequate supplies and will present barriers to people receiving vaccine," said Edward J. Septimus, MD, who spoke for the Infectious Diseases Society of America.

Data from flu manufacturers also suggest that the most significant chunk of the supply actually does go to private physicians, with retail outlets only getting a minority of available doses.

Experts pointed out, however, that these venues are more readily apparent than any other.

The Association also intends to prepare a comprehensive report that will educate physicians on the complexities of flu vaccine supply and distribution.