Some receive flu shot, some don't - and docs are livid

11/30/2000

Kimlea Steinmiller's hands ache from giving so many flu shots.

As a nurse for Interim Healthcare, the agency providing flu shots in area Kroger groceries, she is doling out shots at a record pace.

The most flu shots Interim had provided at a grocery store was 250. This year, the agency is easily using up its maximum supply of 450 shots at each site.

“And we turn away two for every person we give a shot to,” Ms. Steinmiller said.

She shouldn't expect much sympathy from doctors. Problems in the production of this year's flu vaccine have left many physicians' offices without vaccine, and they're fuming as they watch services like Interim Healthcare and others provide shots in grocery stores and pharmacies.

“What we're saying is when something like this [a shortage] occurs, we think people who need it the most should get it first,” said Dr. Walter Wielkiewicz, a Zanesville, O., family physician.

Dr. Wielkiewicz is president of the Ohio State Medical Association, a professional organization representing 15,000 Ohio doctors and medical residents. He said the concern is that otherwise healthy people are getting flu shots before high-risk individuals.

So why do people line up to get flu shots at a grocery store while a doctor's office can't get a single shot?

One reason is vaccine manufacturers often are bound contractually to send vaccines to those who order first. Large companies and health providers usually order months before small doctor practices; so, first ordered, first served.

Regardless of the reason, the Ohio association is irritated. It has sent a letter to the Centers for Disease Control in Atlanta asking the CDC to review how the flu vaccine is distributed.

The doctors can send a letter, but the CDC's hands are tied because it has no regulatory authority over pharmaceuticals.

Dr. Gregory Poland sits on the federal National Vaccine Advisory Committee and said the issue of vaccine distribution have been debated extensively this year.

But in the end, the CDC and others only can ask the states to encourage everyone to limit vaccines to high-risk individuals.

“Those efforts are voluntary and hence have variable success,” he said, noting that flu shots can be a profitable enterprise for grocery stores and other nonhealth providers.

“There's kind of a tension between what should be done at the macro level for public health and the local level where there's an economic conflict,” he said.

Dr. Poland is chief of vaccine research at the Mayo Clinic in Rochester, Minn., which has received only about 4,000 doses of the flu shot but hopes to get 35,000 more shots soon.

Dr. Poland said he has never seen such a problem and this is the first year Mayo has had to ration the shots.

One advantage this year, he said, is that there has been very little flu activity in the country, so “while doctors are getting it late, they'll still have plenty of time” to provide protection to the public.

Toledo might not be so blessed. St. Vincent Mercy Medical Center officials said yesterday that a male patient in its emergency room had a confirmed case of influenza.

Officials with the Ohio Department of Health said they still have no confirmed cases of influenza, and because the St. Vincent case wasn't sent to them for testing, they can't verify it.

However, Dr. Dave Ferner of St. Vincent said the test the hospital used is considered accurate and he has no doubt the man has the flu.

Dr. David Grossman, Toledo-Lucas county health commissioner, said the one case at St. Vincent isn't a cause for panic.

“It raises your eyebrows but it doesn't mark an early flu season,” he said.

For all the talk about the flu, there appears to be an end in sight to the shortage.

Several doctors in Toledo said they've started to see some vaccine shipments trickle in, and all providers of flu shots have been promised supplies no later than Dec. 15.

Dr. Barney Wisinger, a Toledo pulmonologist who treats many patients at high risk for the flu, said he's finally received some flu vaccine, and hopes to get even more next week.

More supplies are arriving at doctors' offices, he said, although in many cases the price has gone up considerably.

“We ended up paying about twice as much as last year,” he said.

Dr. Ian Elliot, president of the Toledo Clinic, said most of the clinic's physicians don't have vaccine yet, but hope to get a supply next week.

“Of course, they [vaccine suppliers] have been telling us that since mid-October,” he said.