Flu Vaccine Shortage: Consumer Options

A Shortage of Vaccine and Price Gouging

With the flu vaccine in short supply many health care facilities are struggling to find enough doses to meet the demand and are being confronted with small suppliers capitalizing on the shortage by demanding as much as 10 times the usual price.

Read the story:Some Suppliers Jack Up Flu Vaccine Price (Post, Oct. 14)

And there's something else for consumers to worry about.

"We are very concerned that the current environment of extremely short supply coupled with high demand will increase the potential for counterfeit vaccine to appear in the nation's drug supply chain," said Kasey Thompson, director of the American Society of Health-System Pharmacists (ASHP), in a press release.

What should consumers do? Who do you trust? How can you avoid being price-gouged?

Thompson was online Monday, Oct. 18, at Noon ET to discuss the vaccine shortage and answer consumer questions.

ASHP's 30,000 members include pharmacists and pharmacy technicians and students who practice in-patient, out-patient, home care and long term care services.

A transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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Kasey Thompson: I'm pleased to be able to join you today for this chat. The American Society of Health-System Pharmacists is the professional organization of pharmacists who work in hospitals and health systems. Almost immediately after the flu vaccine shortage was announced, hospital pharmacy directors began contacting us with reports of price gouging by some secondary pharmaceutical distributors. These distributors are not the major full-service wholesalers where hospitals purchase most of their drugs, but small "secondary" distributors who often fill a niche market providing specialty products. I'm happy to answer questions about how the distribution system works and the public health implications of the flu vaccine shortage.

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Gaithersburg, Md.: Kasey,

After reading the report, "Flu Vaccine Allocation in Area Haphazard
No System Exists for Haves to Share Supply With Have-Nots" by Susan Levine in Saturday's Post, I was disappointed to learn that my Pediatrician in Rockville is administering the flu shots to low-risk children over 23 months of age (Shady Grove Pediatrics 301-330-3216).

Why are they not required to cease dispensing to children over age 2 and divert their unused supply to people who are at the highest risk?

Kasey Thompson: At this point it seems to be up to each state to decide if they want to legally require health care providers to strictly follow the CDC guidelines on who should get vaccinated. The public health community is strongly urging health care providers to adhere to the CDC guidelines when making the difficult decisions on who should receive the flu vaccine. Hopefully the CDC's efforts to allocate the remaining supply of flu vaccine to health care providers who can best reach priority populations will be effective.

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Arlington, Va.: Hello, I am a reasonably healthy 25-year-old. I would like a flu shot, but because of the shortage, I obviously won't get one this year. But, can I get the flu nasal vaccine? Is the government asking for healthy people to refrain from that vaccine as well?

Kasey Thompson: As Dr. Ray Strikas from the CDC noted during last Thursday's chat, "if you are not a health care working with direct patient contact, or have regular contact with children less than 6 months of age, CDC and ACIP are asking that you defer vaccination at this time."

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Boone, N.C.: I have heard over and over of pharmacies, nursing homes and hospitals that last year gave out hundreds or thousands of flu shots, this year these same providers are receiving no vaccine or only a small portion of the amount used last year. If the supply is cut 50 percent why do I sense a more drastic reduction in supplies of vaccine.

Kasey Thompson: Since there are only two manufacturers of flu vaccine licensed in the U.S. What you are seeing directly relates to whether health providers purchased all of their vaccine supplies from one or both manufacturers. For example, if a provider ordered all of their vaccine from Chiron, then they have no supply. If they ordered part or all of their supply from Aventis, then they likely have at least some flu vaccine.

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Kila, Mont.: What government organization is responsible for the formulation, production, and distribution of the influenza vaccine? I would assume it is the Centers for Disease Control ...

It appears that the reliance on a single source of production for the majority of the vaccine is nothing short of mismanagement and incompetence!

Kasey Thompson: The Food and Drug Administration is the federal regulator of pharmaceuticals in the United States. The FDA ensures that drugs are safe and effective prior to approval, and has authority to inspect manufacturing facilities to ensure good manufacturing procedures. However, neither the FDA nor CDC is responsible for distribution of flu vaccine. However, following this year's flu vaccine shortage, it will be important for the federal government to begin a national dialog on how to ensure an adequate supply of flu vaccine in the future.

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Ontario. Canada: Why is it that the government of the United States is curtailing the usage of Canadian pharmacies to alleviate the cost to low income seniors in need of prescription drugs, citing safety concerns but the same government wants Canada to send the flu vaccine, why is one safe and not the other?

Kasey Thompson: The broader issue of not allowing pharmaceuticals to be imported from Canada has to do with the capacity for the FDA to ensure the safety of the drugs being imported from Canada. However, if the U.S. government decides to import flu vaccine from Canada, it will be doing so only after ensuring the safety of the flu vaccine being imported. It is important for consumers to remember that not all drugs purchased from Canada are manufactured in Canada, and that many countries which might be selling drugs to Canada have had significant problems with counterfeit drug products.

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Washington, D.C.: I heard on the radio this morning that the next big crisis will be in the hospitals. About 200,000 people are hospitalized with the flu each year (about 36,000 die from flu viruses). So with 30 million fewer vaccinations, the number of people showing up at emergency rooms nationally may overwhelm the capacity of hospitals. What's your view on this?

Kasey Thompson: It is difficult to speculate on the number of additional flu related illness we will see this year as a result of the shortage, and number of hospitalizations that will result. However, you are wise to point out that it will be important for hospitals to develop a plan in consultation with their pharmacy departments and other health care providers to deal with the potential additional hospitalizations due to influenza. Further, in some cases antiviral medications such as Oseltamivir, Rimantadine, and Amantadine may be used to help prevent influenza.

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Chevy Chase, Md.: How can a consumer confirm that a shot they are being given is not counterfeit?

Kasey Thompson: It is important to remind the public that there have NOT been any reports of counterfeit flu vaccine since the shortage. In almost all cases health care providers purchase their pharmaceuticals from reputable wholesalers or manufacturers who should be able to verify the source of the medications they purchased. ASHP is reminding hospital and health-system pharmacists to make sure they know the wholesaler from which they are purchasing flu vaccine, and to carefully inspect the vaccine container and solution for any irregularities When taking any medication it is important for consumers to report any unexpected side effects they experience to their health care provider immediately. In the case of the flu vaccine, if you experience fever, excessive redness, swelling or pain around the injection site, you should contact your health care provider.

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Arlington, Va.: Why doesn't the government use its power through patents to assure that, as part of a patent, drug companies must make "x" amount of doses of flu vaccine/year? This situation is a national emergency and merits a sound response by the federal government.

Kasey Thompson: Interesting suggestion. Following this year's major shortage of flu vaccine, it will be important for the federal government to take a fresh look at the system by which flu vaccine (and other vaccines) are approved, manufactured, and distributed, and consider significant changes in public policy. Please share your ideas with your representatives in congress.

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Rockville, Md.: I believe that we need to know about the shortage of the vaccine, as has been reported, and reported and reported. BUT ... why isn't there more information being disseminated about how to prevent getting the flu? That's what's needed now. The public should be constantly reminded to wash their hands with ani-bacterial soap, not to handle door knobs, stair rails, etc., sneeze or cough into their elbow, not their hand. Since so many people will be unable to get the vaccine, it is more likely that more people will risk exposure. It is more important than ever that we know how to protect ourselves in every way possible.

Kasey Thompson: Hand washing, covering your mouth and nose with a tissue when coughing or sneezing, staying at home when sick, avoiding touching your eyes, nose or mouth, and avoiding close contact with people who are sick are all important, common sense measures to help avoid the acquisition and spread of the flu virus.

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Silver Spring, Md.: Another question: My company is still planning on offering, as usual, the flu shot to employees. However, the latest e-mail says, "Due to the shortage of the vaccine, the current manufacturer has increased its production and shipment fees. Flu shots will be $25 per individual (cash or checks only) versus the previously announced cost of $20." Does this increase seem reasonable?

Thanks.

Kasey Thompson: I can't address the amount you are being charged for the vaccine, but I do hope that your company is strictly following the CDC recommendations to only vaccinate people who are at greatest risk from serious complications from influenza disease. The CDC recommendations can be found at: http://www.cdc.gov/flu/protect/0405shortage.htm

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washingtonpost.com: 2004-05 Flu Vaccine Shortage: Who Should Get Vaccinated (CDC, Oct. 14)

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FluMist: Earlier in the chat you responded to a question about the nasal vaccine by quoting the CDC recommendation that non-high risk folks not get vaccinated. But I thought high-risk people weren't supposed to use that vaccine, for example the elderly, since the vaccine is for those 5-49. What good is it for us to hold off on FluMist if older people can't use it anyway?

Kasey Thompson: I think what the CDC was trying to convey was that FluMist might be best used by health care providers (who meet the criteria), who are high risk of catching and spreading the disease.

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Kasey Thompson: Thanks for all of the great questions. I'm sorry I could not get to all of them. We know that this is a very challenging time, especially for those individuals who meet the CDC criteria to receive the vaccine, but can not find it. My best advice is to stay up-to-date with CDC recommendations, and keep in touch with your health care provider about the availability of the flu vaccine. Further, make sure you continue to exercise good hygiene and health practices.

Kasey K. Thompson, Pharm.D.
American Society of Health-System Pharmacists

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washingtonpost.com: Centers for Disease Control and Prevention

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