Tuesday, October 19, 2004

Complaints Build Across Nation on Flu Vaccine Supplies

The New York Times
October 19, 2004

Complaints Build Across Nation on Flu Vaccine Supplies

WASHINGTON, Oct. 18 - As the flu crisis stretched into its third week, complaints are building across the country that health officials are failing to distribute the remaining vaccine supply quickly or equitably.

At Louisiana State University in Baton Rouge on Monday, any student who wanted to be vaccinated could obtain a shot, no questions asked. The university Web site, www.lsu.edu, did not mention any restrictions, and a staff member at the clinic, when asked whether anyone could receive a shot, said, "Yeah, you can just walk in."

Dr. Timothy Honigman, medical chief of staff at the student health center, said students who wanted injections were given a fact sheet saying only students at the highest risk should receive the shots. But no one asks students who request vaccine whether they qualify.

"We're trying to do the best we can following the guidelines of the C.D.C., yet not totally turning our back on our students, for whom we are here," Dr. Honigman said, referring to the Centers for Disease Control and Prevention.

A spokesman for the Louisiana Health and Hospitals Department, Bob Johannessen, said several state health officials had called the university to complain about the distribution policy. Mr. Johannessen said health care providers had a moral obligation to ensure - through direct questions and, if necessary, medical records - that people who asked for flu shots were at high risk.

"To vaccinate others,'' he said, "is not responsible and is the wrong thing to do."

Influenza cases have started to appear. Through Oct. 9, scattered cases of influenza were reported in seven states, California, Florida, New York, Pennsylvania, Michigan, Texas and Utah, according to a report posted this weekend on the disease center's Web site, www.cdc.gov/flu/.

On Monday, Minnesota reported its first case, a 44-year-old from Hennepin County. The illness was caused by the A Fujian virus, a strain included in the new vaccine.

Flu causes about 36,000 deaths and 200,000 hospitalizations a year in the United States.

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said that nearly 90 million Americans had a high risk of catching flu, with half of that number usually seeking vaccinations.

The nation has just enough vaccine to provide for this high-risk half, Dr. Fauci said.

Healthy people who are vaccinated, he added, take vaccines from people who need them. The C.D.C. says healthy people from 2 to 64 should "postpone or skip" shots this year.

Hospital officials in New York said the federal government's plan to distribute the remaining supply was too slow. In a letter to Health and Human Services Secretary Tommy G. Thompson, the president of the Greater New York Hospital Association, Kenneth E. Raske, wrote that "there are very large providers in our membership that care for vast numbers of high-risk populations and that have absolutely no adult doses of influenza vaccine."

Hospitals, Mr. Raske added, are starting to share supplies, but remain far short of what they need.

Such sharing is now government policy, Dr. Mitchell Cohen, director of the Coordinating Center for Infectious Diseases at the C.D.C., said.

The vaccine shortage resulted because Chiron, expected to produce 50 million doses, was found to have doses infected by bacteria. Its entire supply was condemned. Aventis Pasteur is now the sole approved supplier in the United States. It expects to produce nearly 55 million doses for this season.

Aventis has delivered 35 million doses to customers, though some may not need all their doses. Health officials are combing through the Aventis customer list, calling clinics and asking whether they have remaining doses that can be redistributed.

Other than redirecting some early shipments, health officials will not be able to satisfy demands for quicker deliveries of more vaccine.

"It's a 'loaves and fishes' problem," a top health official said. "It would take a miracle to get supply to everyone who needs it."

Aventis is shipping two million to three million new doses a week. It plans to deliver its final 20 million doses over the next seven weeks. The company will send the remaining doses mostly to hospitals and nursing homes that the disease centers has identified as particularly needy.

An Aventis executive, Len Lavenda, said that could not be accelerated.

Most of the remaining supply has to be tested for potency. The company performs the time-consuming tests in animals, and the Food and Drug Administration repeats them, Mr. Lavenda said. Bottling the vaccine in vials and hypodermics also takes time, he added.

In most years, the gradual delivery matches vaccination campaigns. But Chiron's closing has caused huge gaps. The New Jersey health commissioner, Dr. Clifton R. Lacey, said his state was nearly out of vaccine. Nursing homes, with 60,000 residents, had no shipments, he said.

In San Antonio, health officials began their campaign on Monday. Nearly 800 people went to two clinics, said Dr. Fernando A. Guerra, health director of the San Antonio Metropolitan Health District.

Dr. Guerra said the district had in placed billboard and public service advertisements encouraging everyone to be vaccinated.

"We suddenly have to change our message," he said.

The district usually distributes 47,000 flu vaccines a year, Dr. Guerra said. It has received 30,000 doses, usually enough to vaccinate all high-risk patients who ask for them, he added, but some hospitals do not have any vaccines.

"So I have to figure out how to allocate some of our vaccines to some other groups," he said.

An editorial in The New England Journal of Medicine this week suggests that officials explore whether diluted vaccine would protect healthy adults and be considered as a strategy to stretch supplies. The disease centers recommends against partial doses.

Marc Santora contributed reporting for this article from New York, and Gretchen Ruethling from Chicago.