Amid problems, U.S. scrambles to parcel out H1N1 vaccine
Friday, October 23, 2009
The federal government's unprecedented campaign to protect the nation against the swine flu pandemic has gotten off to a sputtering start, frustrating parents, pregnant women and others anxious to get immunized against the new virus.
With only a fraction of the tens of millions of doses of vaccine that authorities predicted would be available arriving in states, cities and towns, public health officials who spent months planning for a massive immunization program are instead scrambling to parcel out their limited supply of nasal sprays and shots.
As the number of children, teens and young adults who are falling ill, being hospitalized and in rare cases dying rises, some health departments and doctors are being flooded with calls from worried, sometimes angry patients.
"I'm going to give birth any second. I'm not going to go wait in line for a shot. It's ridiculous. It's so stupid," said District resident Anastasia Dellaccio as she shopped for baby clothes.
Federal officials defended the program Thursday, saying they were frustrated by the slower pace, too. They blamed the lag on the need to ensure the vaccine's safety and effectiveness and unexpected problems such as the virus growing unusually slowly and snags at factories filling vials with vaccine.
The situation is sometimes further complicated by incomplete or conflicting information on state and local government Web sites. Some jurisdictions are making health-care workers a top priority, and others are putting children, pregnant women or other groups first.
The Washington region, despite regular discussions among officials, has a patchwork of distribution plans that has confused some and sent residents skipping from jurisdiction to jurisdiction in search of scant supplies.
Although polls show people remain deeply ambivalent about the vaccine, with less than half sure they want to get inoculated, those who want to are finding it difficult to get. Many health departments have postponed large vaccination clinics and are rationing their supplies to those deemed highest priority.
Woody Townshend of Bowie began looking last month for vaccine for his daughter, Maria, 12, who has cerebral palsy, and bounced through a bureaucratic maze of school and health officials. Finally, on Thursday, Townshend inched Maria in her pink wheelchair through a line in Prince George's County.
"She doesn't walk or talk, so it's not as easy for her to fight off things, especially things that are respiratory," Townshend said. "If she gets sick, it's hospitalization for a week or more. She has a chance of dying. It's scary."
Most officials and the public do not appear to be blaming the federal government, but that might be eroding. A Washington Post-ABC poll released Thursday found that confidence in Washington's ability to respond effectively to the pandemic had slipped from 73 to 69 percent since August.
Although most officials continued to praise the federal government's crash program, some questioned whether organizers raised unrealistic expectations. Officials originally predicted that 120 million doses would be ready by now, then downgraded that to 40 million and last week acknowledged that perhaps only 30 million would be available by the end of the month. Officials now say they expect 50 million doses by the middle of next month and 150 million in December. Only about 15 million doses have been made available.
"Once you draw a line in the sand with a number, that's the number you live and die by," said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who has been advising federal officials. "It's the whole issue of overpromising and under-delivering.
During a sometimes tense Senate hearing Wednesday, Health and Human Services Secretary Kathleen Sebelius said officials hope that by early next month the program will be "back on the track of the number of vaccination doses per week that we had originally anticipated." She repeated a promise that the federal government will provide enough vaccine for every American and noted that it remains crucial that people get vaccinated throughout the winter because of the possibility of further waves.
"We're hoping that as vaccine becomes available and people get vaccinated, that that will at least help to stem the spread," Sebelius said.
Some experts are concerned that the wave of infections in the United States might be peaking and that the bulk of the vaccine will not become available until the disease has taken its biggest toll.
Demand for the vaccine appears to vary around the country, in part depending on how widely the virus has spread. Officials in Michigan, Iowa, Wisconsin, Ohio and Illinois said that although having less vaccine than expected is cause for concern, they have not seen long lines or significant fear or frustration. Demand is high, but people are being patient, they said. Elsewhere, patience is running thin.
"It's frustrating," said Ed Rothstein, a Sellersville, Pa., pediatrician. "We'd like to protect our patients. But we have no idea whether we're going to get it, when we're going to get it or how we're going to get it."
New York, the U.S. city hit hardest in the spring, was initially allocated 1.2 million doses for this month, but the CDC lowered the allocation to 800,000, with most going to hospitals, health-care workers and schools and 185,000 to private doctors.
"We started getting calls at 6 o'clock this morning, by the hordes," said Joyce Schneider, the practice manager at Global Pediatrics, a private practice on Manhattan's Upper East Side in which seven doctors serve 10,000 to 15,000 patients. "People are getting anxious, especially because other offices have it and we don't."
In Portland, Ore., a 25 percent shortfall in available vaccine forced officials to divert the supplies to health-care workers and postpone large clinics at a community college, inner-city church and park.
"I'm ready to roll up my sleeves and give shots," said Lillian Shirley, director of the Multnomah County Health Department. "But we don't have the vaccine."
In Seattle, officials have had to postpone plans to distribute vaccine to individual pharmacies and are instead concentrating on inoculating health-care workers.
On Saturday, hundreds of people arrived two hours before a 9 a.m. public clinic in Pima County, Ariz. -- the fourth held in the area -- that offered vaccine to pregnant women and children 6 months to 2 years old. Within four hours, nearly 1,200 doses were exhausted.
"It was incredible," said Patti Woodcock, spokeswoman for the county health department. "We had two ladies who spent the night in the parking lot -- got there at 10:30 the night before and watched movies in their cars."
One had her five children dropped off the next morning so they could be first in line.
Texas, which had expected to receive 3.4 million doses by mid-October, has gotten fewer than 1 million, prompting officials to limit the vaccine to pregnant women and children.
"People are just calling in constantly and asking: 'Do you have it? Do you have it?' " said Ari Brown, an Austin pediatrician. "We have some people who are angry because they are blaming us."
After waiting for 4 1/2 hours Wednesday in Rockville and being turned away, Kathy O'Grady, a diabetic human resources manager from Germantown, took a second day off work before securing a shot at a less-crowded clinic in Prince George's County on Thursday.
Officials said that even if people cannot get vaccine until later, it will be worthwhile if more waves occur, which has been the case in previous pandemics.
"We are in a race with this virus," Osterholm said, "and so far the virus is winning."
Staff writers Kari Lydersen in Chicago, Robin Shulman in New York and Ashley Surdin in Los Angeles contributed to this report.