Scramble to get flu shots to those at risk
The day after nearly half the nation's flu-shot supply was suddenly ruled unsafe, Massachusetts patients, hospitals, and nursing homes searched for available doses yesterday, as federal health authorities began to intensively monitor the nation's vaccine supply to help direct shots to people most at risk of death from the flu.
Dr. Julie Gerberding, director of the US Centers for Disease Control and Prevention, said the CDC would attempt to identify hospitals and doctors with excess vaccine so that the shots can be redirected to facilities with a shortage, but she insisted repeatedly at a midafternoon press conference that the federal government would not seize the 55.4 million doses now expected to be available and compel their redistribution.
Forced redistribution, Gerberding said, is "not a realistic strategy."
"It would be very disruptive at this point in time to try to go and acquire authority over the vaccine supply," she said.
Gerberding said federal authorities plan to work with Aventis Pasteur, the lone remaining supplier of flu shots, and rely on the goodwill of hospitals and doctors to manage the shortage that developed Tuesday when British regulators suspended the production license of a Liverpool, England, factory run by
The state Department of Public Health early yesterday evening issued an advisory to doctors and hospitals, telling them to immediately stop immunization clinics that target the public broadly and urging them to abide by federal emergency recommendations that the vaccine be restricted to those most in danger of getting the flu virus, including the elderly, young children, and people with chronic illnesses.
Public Health Commissioner Christine C. Ferguson said her agency is developing a vaccine-distribution system that will try to supplement the federal efforts.
"There's not a system in place right now to retrieve vaccine and redistribute it," Ferguson said. "But we're in the process of having conversations with people about how to do that."
CDC estimates show that nearly 95 million adults and children fall into the high-risk category, nearly one-third of the population. A comparable proportion of Massachusetts residents qualify as high-risk, about 2 million people, state disease trackers said. But in a typical year, not everybody who is considered at high risk gets vaccinated. Almost 90 million Americans received flu shots last year, but that included many who were healthy and young and had been encouraged to get immunized by public health campaigns and workplace drives.
The state government has ordered 168,000 doses from Aventis and is attempting to ascertain how many doses of the Aventis vaccine have been ordered by private doctors and hospitals in the state.
Gerberding made her pledge to get vaccine to those most in need as a half-dozen scientists from the Food and Drug Administration prepared to travel to London to meet with British regulators who shuttered Chiron's flu vaccine production line over concerns about bacterial contamination. They want to know the precise reasons for the regulatory action, said US Secretary of Health and Human Services Tommy G. Thompson, and to determine if any of the Chiron doses of a shot called Fluvirin can be salvaged for use.
Thompson said the FDA scientists would endeavor to "find where the disputes are and how we can reconcile them."
Still, Thompson said he was not optimistic. "It does not look promising," he said.
Thompson said Aventis had told federal health agencies that it will have about 1 million more doses than it originally forecast.
That was small comfort to Boston-area hospitals, nursing homes, and patients, who were scrambling to land vaccine reserves that had not already been claimed. Doctors reported that their offices were inundated by patients, both healthy and those most at-risk, inquiring about the availability of flu vaccine. At one Copley Square pediatric practice, 1 of every 5 callers asked about shots.
Major teaching hospitals such as Massachusetts General Hospital and Brigham and Women's Hospital that had planned to buy most of their vaccine from Chiron confronted deep shortages yesterday: Mass. General, for instance, had expected to give up to 60,000 doses, but by yesterday had only 10,000 from Aventis. Hospital leaders were beginning the difficult process of deciding how to ration a scarce supply.
Doctors are grappling with how much of the vaccine should go to doctors and nurses who need to stay healthy to tend to the sick, how much should go to patients at-risk, and how to determine who the at-risk patients are.
"We have some real judgments to make," said Dr. Brit Nicholson, chief medical officer at Mass. General. "We have not explicitly been in the business of rationing vaccines before."
The decision is made all the more difficult because doctor's can't predict how bad the flu season will be, and how effective the available vaccine will prove.
"If there are fewer vaccine doses out there and we do have a heavy flu season, then the crush on our hospitals is going to be even greater," Nicholson said, "and it's going to be even more important to do everything possible to make sure every bed is open and available."
At Brigham and Women's, which now expects to receive only half as many doses as hoped, doctors have scrapped plans to for the first time vaccinate virtually every patient, regardless of age or medical condition, said Dr. Robert Goldszer, associate chief medical officer.
And at Caritas St. Elizabeth's Medical Center, doctors were considering giving patients flu medicines to prevent the illness, rather than treat it. But that option would cost substantially more than vaccines, and it would require patients to take medication for up to one month, said Dr. Michael Worthington, chief of infectious diseases at the hospital.
The sudden vaccine shortage was felt most acutely yesterday at the area's nursing homes, an ideal environment for a swift and lethal flu outbreak.
"All you need is one person to come in, and it will spread like wildfire. That would be deadly. It will kill older people," said Dr. Robert Schreiber, physician-in-chief of the Hebrew Rehabilitation Center for Aged in Jamaica Plain, which cares for 650 elderly patients in its main facility and 3,000 at satellite centers, but had no flu vaccine as of yesterday.
The center, like many other area nursing homes, is on an Aventis waiting list. Schreiber yesterday placed extra orders for drugs to treat flu symptoms and considered prevention measures recalling more exotic disease outbreaks: "We could end up screening people who come in to visit, like during the SARS epidemic," he said.
Pharmacies, which have become major flu-shot providers in recent years, moved to modify their vaccine campaigns. In a typical year, Walgreens, which uses the Aventis vaccine, offers shots for $20 to anybody with the cash to pay. But the chain ordered its stores yesterday to restrict vaccinations to high-risk people.
At Newton-Wellesley Hospital, which has an extensive network of physicians, Dr. Mark Drapkin, the hospital's associate chief of infectious disease services, sent out a mass e-mail requesting that doctors share vaccine as needed. "It's not fair that if you're a 67-year-old patient and your doctor has ordered from Chiron, you won't get it. That doesn't seem right," he said. "I hope that in our little community here we can rationalize distribution of the vaccine."
Stephen Smith can be reached at stsmith@globe.com.
