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Vaccine Shortage Turns to Surplus

U.S. Is Likely to Lift Restrictions and Urge Flu Shots

By Rob Stein
Washington Post Staff Writer
Saturday, January 22, 2005; Page A01

The nation's shortage of flu vaccine has turned into a surplus, with nearly 5 million doses languishing in the federal government's hastily purchased stockpile, officials said yesterday.

With demand dwindling, it appears likely that instead of running out of shots this year, the government will end up discarding unused vaccine, they said.

Jessica Ody vaccinates Peggy Laboda of Parma, Ohio, with granddaughter Juliette Laboda. The shots were originally limited to high-risk populations. (Lonnie Timmons Iii -- Cleveland Plain Dealer Via AP)

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In response to the surprising turnaround, the federal Centers for Disease Control and Prevention in Atlanta is poised to drop the remaining restrictions on who should get the shots, a move already taken by at least 17 states, in a last-ditch effort to minimize the amount of wasted vaccine. New York took that step yesterday.

In addition, federal and state officials have launched a campaign to persuade more people to get vaccinated, especially those at highest risk from the flu, before the peak of the season hits, probably in the next month or two.

"We're trying to get that message out -- the disease hasn't peaked and there's still time," said Jeanne Santoli of the CDC's National Immunization Program. "It's not too late to protect yourself."

The surprising surplus appears to be the result of a combination of factors, including the spotty availability of vaccine, a relatively mild flu season so far and too many people voluntarily forgoing shots to help out those perceived as more in need, officials said.

But in addition to potentially wasting taxpayer dollars and leaving many people unprotected, the surplus has prompted concern that the confusing situation could have long-term implications for the nation's ability to protect itself against the flu, which claims thousands of lives each year.

A surplus would make it even more difficult to persuade manufacturers to produce more vaccine in future years, a goal public health officials have long pursued, as well as undermine years of efforts to encourage more Americans to get routinely vaccinated, experts said.

"The problem with a set of stuttering, changing recommendations year by year is confusion," said Greg Poland of the Mayo Clinic. "I worry that it sends the wrong message to the public about the seriousness of influenza and the imperatives for why they should get immunized. One year we say 'You're in the high-risk group,' and then next year we say 'You're not.' The public is confused."

The surplus is the latest twist in a tumultuous series of events that began in October, when manufacturing problems at the Chiron Corp. plant in Liverpool, England, suddenly cut in half the expected U.S. supply of 100 million doses.

In response, the CDC said the vaccine should be reserved for those at highest risk, primarily children, the elderly and the chronically ill. The restriction triggered panic around the country, with people waiting in long lines for shots, often fruitlessly. To try to compensate, the federal government took over the allocation of the remaining supplies and bought whatever excess vaccine was available elsewhere.

But only a fraction of those eligible for the vaccine have gotten inoculated, in part because many gave up after failing to obtain shots initially and in part because many decided to skip their shots to leave enough for others. In response, the CDC relaxed its guidelines slightly in December to encourage more people to get vaccinated.

Those moves, however, failed to bolster demand significantly, partly because the flu season has been relatively mild so far. A CDC survey last week found that only 10 states said they may need more vaccine, making it unlikely the remaining federal reserves of nearly 5 million doses will be sold, officials said.

"We do think there will be some vaccine left over at the end of the season," Santoli said. "Every season we see this, but this year it's particularly concerning because of all the energy people put into targeting vaccine and all the people who stepped aside. We are doing everything we can to get these doses used, because we really want to minimize the amount left over."

Agency officials are discussing relaxing the remaining restrictions to spur demand, Santoli said.

"That certainly is a possibility," she said. "There are discussions about whether the guidelines will be broadened, particularly in light of the fact that all these states have done it."

Several experts endorsed such a move.

"I think it would be a shame if we didn't use all the vaccine that we have," said Myron Levin of the University of Colorado, the chairman of an expert committee that advises the CDC on vaccine issues.

But several experts said it will be difficult to generate much more demand.

"The vaccine we have now was delivered in December and January. That's a little out of sync when most people want to use the vaccine, and that's part of the problem," said William Schaffner, a flu expert at Vanderbilt University.

In addition, many doctors and clinics are hesitant to order more so late in the season for fear they will be left holding the bill for unsold vaccine.

"Many providers were unable to get vaccine early in the season and they're hesitant to order vaccine now because of financial risk," said Howard Backer of the California Department of Health Services. "A lot of them are thinking, 'I'm not going to be stuck with vaccine. It's money thrown away.' " In Kansas, where all restrictions on eligibility were dropped last week, demand increased slightly in some areas but plenty of shots remain available, officials said.

"We're still not seeing much of an increase in demand," said Sharon Watson of the Kansas Department of Health and Environment. "We're still hearing from providers that they still have excess vaccine."

Officials in Virginia, Maryland and the District said that although some doctors and clinics may not have the vaccine, supplies are generally available through local health departments. All three jurisdictions are awaiting word from the CDC on whether to further relax their restrictions on eligibility.

© 2005 The Washington Post Company


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