ARMING FOR THE
When Billie Derivan recalls last year's flu season, she gets a sick feeling.
Ms. Derivan, the director of the James "Wes" Hancock Senior Center in Oregon, set up three flu shot clinics targeting high-risk individuals like senior citizens. Then it happened.
The nation was hit with an unprecedented shortage of flu vaccine. Seniors and others seeking shots stood for hours in grocery stores, senior centers, anywhere that was offering flu shots, in an often futile attempt to find the vaccine.
"The first clinic we did last year the scare had not hit yet, so it was very quiet. Then as the fear spread, the second one we had people in our parking lot at 4 a.m.," she said. "By the third one, people came out at midnight and sat all night in their cars."
So with this year's flu season on the horizon, one can't blame those like Ms. Derivan for being a little nervous.
"I'm hoping that it won't be as frantic," she said. "I'm hoping we'll be able to get the seniors inoculated peacefully without raising their blood pressure ... I just don't want panic again. We had people crying [because they couldn't find a flu shot]."
No one's promising there won't be another shortage this season, but so far everything appears normal, according to Dr. William Schaffner, a member of the National Foundation for Infectious Diseases.
"I'm actually feeling very comfortable. So far, so good," Dr. Schaffner said.
Ohio and Michigan health officials don't expect any problems, but the situation at area private physician offices is harder to gauge. Dr. Jeanne Santoli, an influenza expert at the federal Centers for Disease Control and Prevention, agreed with Dr. Schaffner's optimism, saying several steps have been taken to prevent another shortage.
The government expects to have four licensed manufacturers of flu vaccine this year, up from only two last year. Last year's vaccine shortage was caused when about 45 million doses from British supplier Chiron - representing nearly half of America's anticipated supply - were deemed contaminated. That left only about 58 million doses available from the other main U.S. supplier, Aventis Pasteur, with a few million more from other sources.
Sanofi Pasteur (the new name of Aventis Pasteur) expects to produce 60 million doses this year and has already started shipping some vaccine. GlaxoSmithKline is producing 8 million doses. The makers of the nasal spray "FluMist" expect to produce 3 million doses. And Chiron has passed government inspections and is expected to produce 18 million to 26 million doses this year.
"That's about 97 million doses, and last year we had only 61 million doses, much less than we normally have," Dr. Santoli said. "And this year we've put into place plans to target the vaccine to high-risk people first."
What that targeting plan means is that the federal government is telling doctors and others giving flu shots to only vaccinate high-risk individuals, such as those 65 and older, now and to wait until Oct. 24 or later to vaccinate anyone else.
Also for the first time this year, the CDC has developed a "subprioritization" plan. If a shortage develops, existing flu vaccine will be given only to high-risk people most in need. For example, though everyone 65 and older is in a high-risk group, in the event of a shortage, only those 65 and older with chronic diseases or other health problems will qualify for a shot.
But, Dr. Santoli cautioned, "nothing we've seen so far makes us think we'll have to do that."
Dr. Schaffner, chairman of the preventive medicine department at Vanderbilt University as well as an adviser to the government on vaccine policy, said another improvement was the federal government increasing the reimbursement it provides to doctors to give Medicare recipients a flu shot. That increased financial incentive should encourage more doctors to provide the vaccine, he said.
Another concern this year is the bird flu. Public health officials have been warning for months that bird flu, which normally circulates among the wild and domestic bird population, could mutate into a form that could rapidly spread through the human population.
"Every time you mention bird flu, all of us shiver a little bit," Dr. Schaffner said of the public health community's nervousness. "We don't know what's going to happen, but the threat is real."
There have been human cases, but they don't appear to be those spread human-to-human. Some people have been infected and died after coming into close contact with infected poultry and other animals.
Dr. Santoli said if the bird flu does mutate, it could be devastating; killing half of those who catch the flu. The government is testing vaccines that might counteract a bird flu virus, and is stockpiling Tamiflu, an antiviral drug that can fight flu symptoms.
Dr. Schaffner said while he supported the improvements Dr. Santoli referred to, he's still disappointed the federal government didn't take bolder steps to prevent a repeat of last year's shortage. For example, he's long pushed for setting up a national adult immunization program that would put an infrastructure in place to rapidly vaccinate the entire U.S. population if needed.
Currently, flu vaccine is provided through the private sector and some government agencies, but there's no overall central authority controlling vaccine supply or distribution.
"I find that [lack of effort] a colossal disappointment. I mean how much more of a wake-up call did we need than last year?" he asked. "There was a terrific opportunity to examine the structural weaknesses. I'm sorry to use this metaphor, but this is like ignoring the problems with the New Orleans levees. I mean how much more information do we need?"
There also is no central clearinghouse of information at the federal level, or in most states, as to where people can get a flu shot. A frequent complaint among those seeking shots last year was no one could tell them with any certainty who had flu vaccine available.
Ohio and Michigan have no plans to try and provide such information. Some local health departments have tried to do so. The Toledo-Lucas County health department, for example, will for the first time maintain a flu shot hotline and try to provide the public with all known locations for shots, including those at private entities like grocery stores, in Lucas County.
Dr. Santoli said one idea that is beginning to quietly resurface is whether the country should attempt "universal vaccination," meaning everyone, not just those at high-risk, should get a flu shot. Doing so would require a big investment and perhaps establishment of a national adult vaccine program like Dr. Schaffner suggests.
Federal experts will discuss such a proposal later this month, though nothing definitive is expected, she said.
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