A few short months ago, health officials were worried about this year's flu season because of a sudden shortage of the vaccine. Only two companies manufacture flu vaccines for the entire United States of America, and one of them was unable to deliver the product. New York City started the season in October with 600,000 fewer vaccine shots than officials said they needed and, along with the rest of the county, implemented a policy allowing only people at "high risk" for the disease to receive shots.
Now, health officials are still worried, but for a different reason. There is an adequate supply in New York City for groups at risk. The problem is now the demand. "We don't want those doses to go to waste," said Dr. Julie Gerberding, director of the federal Centers for Disease Control in an announcement in December recommending the list of "priority groups" for the vaccine be expanded.
Fewer Shots, More Flu
Influenza is more than an inconvenience. It causes an average of 36,000 deaths a year in the United States and sends about 230,000 people to hospitals.
Yet, as of December 22nd, only 17 percent of Americans had received flu vaccines, half as many as last year or the year before, according to a Wall Street Journal Online/Harris Interactive health-care poll. And of at-risk adults who qualify for the shots, 47 percent reported they had not even tried to get one this year.
Not surprisingly, flu cases are reportedly on the rise. New York was the first state to report "widespread influenza activity" according to the Centers for Disease Control.
The New York City Department of Health and Mental Hygiene announced on December 21st that it "had identified 21 outbreaks in health care or other institutional facilities so far this season, nearly twice as many as had been reported by this time last year." The department also reported there are now adequate supplies of flu vaccine in New York City and advised the medical community to "make sure patients at highest risk of serious illness from the flu get vaccinated."
No Longer A Shortage For New Yorkers At High Risk
In New York City, the shortage of vaccine shots was addressed when federal health officials made plans in November to divvy up the national supply of vaccine based on the concentration of high risk groups in different areas. The city has already received 900,000 doses of vaccine from the federal government and anticipates receiving over 275,000 more.
To further alleviate the problem, New York City joined Illinois, New Mexico and Cleveland in a bid to obtain additional doses from European manufacturers. However, the federal government is still deciding whether it will allow the vaccines into the country, and flu season may be over by the time it does.
For now, New York City health officials say there is still not an adequate supply to vaccinate everybody, but there is enough for those considered high-risk:
- People 65 and older. (The city is now considering lowering the age to 50);
- Children 6 to 23 months of age;
- Residents of nursing homes and chronic-care facilities;
- People age 6 months and older with chronic medical conditions, including heart disease, pulmonary disorders (including asthma), diabetes, kidney disease, hemoglobinopathies, and compromised immune systems (HIV or immunosuppressive therapy);
- Women who will be pregnant (at any gestational age) during the influenza season;
- Children and adolescents, age 6 months to 18 years, receiving long-term aspirin therapy;
- Healthcare workers providing direct patient care;
- and caregivers of children under 6 months of age.
Flu shots are now available for these groups, but media coverage of the flu epidemic has declined, and health officials seem worried the shots will go unused. "Many New Yorkers were discouraged from seeking a flu shot this season, even as more vaccine became available," New York City Health Commissioner Dr. Thomas R. Frieden said in a statement. Because so many people stayed home rather than receiving their annual flu shot, he said, "there are likely to be more flu-related deaths this year."
Is There A Better Way?
Stephen S. Morse, director of Columbia University's Center for Public Health Preparedness, says this is not necessarily true. It is hard to predict the virus's movement or gauge the efficacy of the health department's vaccination program this early in the flu season. "It's always an issue of supply and demand," he said, "and only time will tell if the hard-working health department predicted the demand correctly." Last year, he added, the companies producing the vaccines anticipated too large a demand and over-produced the shots. "They ended up throwing out 10 million doses nationally."
It is especially hard to make predictions when the two major forecasters each year, public health departments and private drug companies, have different agendas. For the drug companies that produce the vaccines, profits remain an issue -- and flu vaccines are generally not very profitable. For one thing, they are only administered once; other drugs may be taken several times a day for long periods of time.
Additionally, the cost is high for identifying the particular strain of flu set to arise each year and producing a new vaccine to combat it. And in some cases, scientists make incorrect predictions, meaning months of work -- and months of funding -- are wasted. For these reasons, Dr. Morse said, many drug companies opt not to make flu vaccines. If it turns out that this year's demand exceeds supply, however, more companies, such as those operating only in Europe, may want to jump in.
European countries have avoided shortages by relying on more pharmaceutical companies for the vaccines. Health experts overseas have long criticized the U.S. handling of flu vaccines, according to the New York Times. Britain "spread its order for flu vaccines among five suppliers, precisely to avoid the kind of predicament America now faces."
There are also vaccines that have been approved for use in Europe but not in the United States. More approved vaccines could mean less reliance on a single company. This season, Fluarix, a vaccine used in Europe but not here, was authorized on an emergency basis for use in the United States. Reuters reported that health officials agreed to buy up to four million doses of the vaccine from a plant in Germany.
Drug companies might be interested in producing more than just vaccines. Antiviral drugs can be used during vaccine shortages to treat high-risk groups, such as the elderly living in nursing homes, where disease spreads quickly. Antivirals make it impossible for the virus cells to reproduce in the body and can be used to prevent or treat certain types of flu.
According to a recent study at the University of Vermont Medical School published in the New England Journal of Medicine, amantadine, one of these drugs, was 91 percent effective at preventing the flu in a group of 450 volunteers. Dr. Alan Kendal of the federal Centers for Disease Control said that, ''in special cases, such as an epidemic of flu at a nursing home, amantadine may serve as a useful supplement in protecting high-risk people in the period before the vaccine can take effect.''
Though antiviral medications work well, there are several problems with relying on them for treatment. To prevent the flu, they must be taken within two days of getting sick, according to a report from the Centers for Disease Control. Because they are available by prescription only, people must see a doctor at the first sign of the flu to receive them. Though they can shorten the length of infection, for a typical weeklong bout, the difference in recovery time would be only a day or two. Further, the antivirals only work for type A influenza, not the common cold or other forms of the flu.
For the most part, antivirals are used in combination with vaccines to treat people at risk of complications from influenza. According to the statement, they are most often used "to control flu outbreaks in institutions, for example in nursing homes, or in hospital wards, where people at high risk for complications from flu are in close contact with each other."
Due to the vaccine shortage, antiviral drugs have been widely used this year. The American Society of Health-System Pharmacists quoted Health and Human Services Secretary Tommy G. Thompson as saying that this year the country would have enough antiviral drugs to care for about 40 million people. It also reported that "the CDC is concerned about the development of drug resistance if the products are used for treatment as well as prophylaxis."
As health departments increase supplies of vaccine and antivirals, and media attention to the issue declines, Secretary Thompson advised people in high-risk categories to be "patient but also be persistent" in seeking vaccine.
For more information about flu, or where to get a flu shot from the Health Department, call 311 or visit the department's flu page.