Chiron Corp., one of only two suppliers of flu vaccine to the U.S. market, gave notice on Oct. 5 that Britain had suspended its license because of bacterial contamination at its Liverpool plant. About half of the U.S. 2004-2005 supply abruptly went away. The remaining supply - about 55 million shots made by Aventis Pasteur US - is being rationed. Emergency room doctors warn a surge in flu cases could overwhelm their limited ER beds and force hospitals to postpone elective surgeries.
There's no cause to panic. Instead, Americans can follow Centers for Disease Control guidelines on vaccinating high-risk populations. Health administrators, homeland security officials and the Congress need to determine whether the government has built enough redundancy into the supplier system. The government may need to offer incentives to guarantee a stable supply of influenza vaccine each year.
But even a stable supply doesn't assure that emergency rooms won't be overwhelmed. "Last year, plenty of vaccine was available, but the flu strains used didn't cover a new one that developed," said Becky Tacy, nurse manager at St. Elizabeth hospital's emergency management department in Northern Kentucky. "It was horrendous last year." Despite this year's sudden shortage, she insists for healthy people flu is not an emergency. Many cases can be prevented if we follow the guidelines. The CDC is trying to ration shots with highest priority going to children ages 6 months to 2 years, adults 65 or older, people with chronic medical conditions, health care workers and similar high-risk populations.
Tacy says people who unnecessarily go to an ER add to the problem, and end up disgruntled when sicker patients are triaged ahead of them. Last year, St. Elizabeth taught ER visitors the basics of "cough etiquette" (cover mouth), hand-washing and other preventive steps. She said this year we could see higher absentee rates for teachers and nurses. The shortages will test how effective preventive measures can be.
The United States used to have more than a dozen vaccine suppliers. Now it's down to one, a U.S. subsidiary of French-owned Aventis. Most drug companies want no part of the yearly gamble and losses - some years in the tens of millions of dollars.
The government may need to subsidize suppliers against big losses. There is an overlap between national security and "health security." A pandemic like the 1918-1919 Spanish flu would be far more crippling than the 9/11 attacks. U.S. flu deaths in the 1990s averaged about 36,000 a year. Just as we try to save U.S. steel makers and high-tech industries for national security reasons, it may also be smart to nurture domestic vaccine makers. Some critics blast the administration for wasting millions on bioterror prevention instead of supplying enough vaccine for flu - the bigger killer so far.
We need to get back to encouraging more people to get flu shots instead of asking many now to skip it.
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