Another Year, Another Botched Flu Program by the CDC

Well, if this is October, that must mean:

• Halloween is right around the corner?
• Ads promoting Christmas shopping will appear any day now?
• The weather is turning colder?

Yes, but . . .

If this is October, it means we have another shortage of flu vaccine. This time, though, with both the "regular" flu and the swine flu, we're doubly blessed. We have a shortage of both. Again. As usual. For years now. You can set your watch by the predictability of the shortage.

Except the Centers for Disease Control (CDC) doesn't always call it a shortage. Some years it's just a distribution problem. Some years it's increased demand. Some years it's a manufacturing problem. Some years, it's that the flu season began earlier than expected. Some years it's something else. Point is: There's seldom enough, early enough.

It reminds me of a little kid who gets "Fs" in all his classes. The teacher doesn't like him. He forgot his books one day. The dog ate his homework. He missed the school bus. The assignment was confusing. There were some pop quizzes he hadn't expected. The other kids cheated. It goes on and on and on. But the result is always the same: Failure.

Let's take this year first.

Here's the official CDC line. This is from a telephone news conference on October 6. Thomas Frieden is the CDC spokesperson. I've added the bold/italic for emphasis:

Mike Stobbe: Thank you. Mike Stobbe from the AP. Doctor, can you give us an updated number about how many doses will be available this week? Also, is demand outstripping supply. Is supply outstripping demand at this point?

Thomas Frieden: This week, as of yesterday, about 2.4 million doses were available for ordering. About 2.2 million of them had been drawn down or ordered by this week. Each day, as more vaccine is clear, more vaccine becomes available for ordering, each Friday we'll provide the totals. Some which would have become available that Thursday or Friday. We're trying to make sure that we cut as much time as possible off the cycles to get it out and available for providers to vaccinate. To do that, means a little bit of messiness on how it comes out. If there's a minor problem with any of the vaccine in any of the warehouses, we don't have it available for ordering. We have to make sure it's safe and temperature-controlled. Before it will be released to the states. Some lack of certainty. We have a high degree of confidence by middle October, we'll have substantial amounts of flu vaccine available. Clearly at this point, only some vaccine and not everyone can receive that vaccine. Demand is outstripping supply. We expect that fairly soon, supply may well outstrip demand. The challenge will be to try to ensure the people who benefited the most have every opportunity to be vaccinated. On the phone?

Operator: Our next question is from "Time" magazine.

Alice Park: A question about the supply issue. Looking ahead, did the calculations that the CDC made as far as the ordering include the potential that more and more individual entities would mandate the vaccine for their health care workers. In New York, mandated it for the entire state that right now, we're having problems with getting the seasonal vaccine in enough supply? More entities demanding the vaccine, therefore a higher rate of compliance or demand for the vaccine than you have had in previous seasons?

Thomas Frieden: We're very confident that there will be plenty of vaccine for everyone who wants to be vaccinated. It won't be available when everyone wants to be vaccinated. Providers will receive it from directly from the manufacturer. Information should be available to the public through the state health department, to find out the details of where it will be available. That's not ready quite yet. Because, there are not large quantity -- there is not a large quantity of vaccine available today. Out there to be given H1N1. Seasonal flu vaccine, some areas have had less. They're well over 50 million doses distributed earlier. We're particularly Prioritizing those key groups I spoke about earlier.

And here's how it's being reported in the media from around the country:

CVS Ending Flu Shot Clinics Early
(Chicago, IL) -- CVS is ending its seasonal flu shot clinics ahead of schedule due to a shortage of the vaccine. The drugstore chain announced this week that the clinics will only run through October 22nd instead of lasting until the end of November as planned. A spokesperson for CVS blamed the vaccine shortage on manufacturer delays and consumer demand that was much higher than the drug store anticipated when it started the inoculation program last month.

Seasonal flu vaccine shortage hits Long Island
The seasonal flu vaccine is in short supply or out of stock across Long Island, forcing the suspension of flu clinics at pharmacies and malls, and causing frustrated doctors to add patients' names to ever-growing waiting lists. The shortage is attributed to the struggle by manufacturers to produce vaccines this year for both seasonal and swine flu amid unusually high demand for the seasonal flu shots. The shortage is being felt nationwide and is expected to continue until next month, federal health officials say. "There is also a greater awareness of influenza this year and a desire among people to get their influenza vaccinations earlier and for providers to get the seasonal out of the way so they can focus on H1N1," said Donna Cary, spokeswoman for Sanofi-Pasteur in Swiftwater, Pa., the nation's largest flu vaccine maker.

Seasonal flu vaccine shortage across Southeast Texas, U.S.
If you're on the hunt for the seasonal flu vaccine, you may have a tough time. Two of the nations largest drug store chains are reporting shortages at some of their stores and dozens of pharmacies around the Golden Triangle say if they're not completely out of the shot at this point, they're getting close. The amount of phone calls to King's Pharmacy in Beaumont hasn't changed lately, despite the fact that the answer to the most popular question... has changed. Pharmacist Greg Hamby said, "I've had the story several times that they find someone and by the time they get there the supply is exhausted." And it's the same story most pharmacies are hearing from families in search of the seasonal flu vaccine. This year, the shot has garnered some of the highest demand in years. The problem is... the supply can't meet that demand.

Flu vaccine shortage widening
One major supermarket chain is canceling in-store seasonal flu vaccines later this month, while other retailers say their supplies are also dwindling. Still need an annual flu shot? Good luck. Spot shortages in seasonal vaccine in the Philadelphia region are expected to worsen with three major supermarket chains anticipating they'll likely run out before the end of the month. Local pharmacies report they've been bombarded with people unable to get a routine flu shot at private health care providers because of shipment delays and incomplete orders. Now Giant Food Stores and Martin's Food Markets Friday announced its in-store pharmacy flu clinics will end after Oct. 22. Company officials say their distributor has informed them several winter vaccine orders previous promised will be unfilled.

This isn't the first time--or the second time--or the third time--or the fourth time--that there's been a shortage of the flu vaccine. It happens nearly every year.

Let's take a trip down memory lane.
 
2004-2005
From a report by the Government Accountability Office:

For the 2004-2005 flu season, despite early indications that one manufacturer was having production difficulties, CDC published guidance in September 2004 stating that it did not envision any need for tiered vaccination recommendations or prioritization of vaccine for those at higher risk of flu-related complications. Following the suspension of one manufacturer’s license and the announcement it would not supply any vaccine to the U.S. market this season, CDC revised its recommendations and took steps to mitigate the vaccine shortage.

2004
From a report by the Government Accountability Office:

Although these actions helped achieve vaccination rates approaching past levels for certain priority groups, such as those aged 65 years and older, several lessons emerged, including some that could help with future shortages. First, unless planning for problems is already in place, action is delayed. CDC’s lack of a contingency plan contributed to delays and uncertainty about how to ensure that high-risk individuals had access to vaccine. Second, when actions occur late in the influenza season, they are likely to have little effect. Third, effective response requires communication that is both clear and consistent. CDC has taken a number of steps, including issuing interim guidelines in August 2005, to respond to possible future shortages. It is too early, however, to assess the effectiveness of these efforts in coordinating actions of federal, state, and local health agencies and others.

And this from the New York Times:

In recent years there have been many significant disruptions of vaccine supplies. Between November 2000 and May 2003, there were shortages of 8 of the 11 vaccines for childhood diseases in the United States, including those for tetanus, diphtheria, whooping cough, measles, mumps and chicken pox. There have been flu vaccine shortages or miscues for four consecutive years.

2003-2004
From a report by the Government Accountability Office:

For the 2003-2004 flu season, shortages of vaccine were attributed to an earlier than expected and more severe flu season and to higher than normal demand, likely resulting from media coverage of pediatric deaths associated with influenza.

2000-2001 
From a report by the Government Accountability Office:

In 2000-2001, when a substantial proportion of flu vaccine was distributed much later than usual due to manufacturing difficulties, temporary shortages during the prime period for vaccinations were followed by decreased demand as additional vaccine became available later in the year.

I could go on and on, but the point is: There's always an excuse. Sometimes two or three excuses. Demand was higher than anticipated. There were manufacturing difficulties. There were distribution difficulties. The flu season began earlier than expected. Or the CDC's non-shortage approach: There will be plenty; it just won't be there when people want it.

This isn't an argument for or against the use of the vaccine itself. Some folks won't use it for a variety of reasons. That's their decision. But for those people who do want it, why can't the CDC do it right for once? And since this blog primarily focuses on the elderly--who are judged to be among the categories most at risk--the debate about the availability of both the regular flu vaccine and the H1N1 vaccine is highly relevant.

The CDC is doing a fine public relations job with social media: buttons and badges, e-cards, Twitter, online videos, podcasts, Facebook, MySpace, Whyville, and more. See more details here. But you can't make a silk purse out of a sow's ear. Or a silky image out of swine flu.