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Vaccine Industry Needs Shot in the Arm

Reports find questions about supply, cost and availability

TUESDAY, May 10, 2005 (HealthDayNews) -- The fact that many Americans underestimate the health threat posed by the flu may have been an big factor in helping the nation cope with last fall's vaccine shortage, a new survey finds.

The results appear in the May/June issue of Health Affairs, which also contains two other reports that look at the state of vaccine programs in the United States. One found that an estimated 40 million Americans with health insurance don't have coverage for all vaccines. Another study found that production of pediatric vaccines is becoming consolidated among a handful of manufacturers, a potentially worrisome development if, for example, one maker were to experience supply problems.

For the flu survey, Harvard University researchers questioned 1,227 adults on their knowledge of the flu's health threats. The researchers also asked the respondents how they thought the federal government had handled the loss of nearly half of 100 million vaccines last fall when one of the nation's main manufacturers temporarily lost its license to produce vaccine. The survey also asked if the same rationing response by federal officials -- asking only high-risk individuals such as the elderly or chronically ill to get a shot -- would work with shortages of other vaccines for contagious diseases.

The survey found that more than 50 percent of those interviewed underestimated the potential dangers of flu, and only 10 percent knew that flu accounts for about 20,000 to 40,000 deaths each year in the United States.

The researchers speculate this lack of awareness may have been an important reason why many people didn't get a flu shot last fall, enabling federal health officials to manage the potentially dangerous vaccine shortage.

"Older people were concerned about the shortage," said co-author Robert J. Blendon, a professor of health policy and analysis at the Harvard School of Public Health. "But a lot of people who were not older had mixed feelings about getting the flu vaccine. Many felt it had side effects or didn't work. And it was relatively easy to tell them to stay away."

What's more, many people believed that measures such as hand washing were more important than getting the vaccine, Blendon said. Most people surveyed also objected to the government's rationing of the vaccine: 56 percent said doctors and nurses should decide who should get a shot.

Despite the apparent success of rationing flu vaccine last year, Blandon doesn't think it can serve as a model for rationing vaccines for other dangerous diseases. "The reason it was so easy to allocate the vaccine to high-risk groups was because other groups weren't that interested in getting it in the first place," he said.

But, he added, it's not clear that a shortage of vaccine for a more serious disease would leave people comfortable with the federal government setting priorities for who should get shots.

"If this were small pox, if this were avian flu, you would find a considerable number of people who would say, 'The heck with these guidelines, I want my doctor to give it to me right away,' " Blendon said.

One expert agrees that the rationing system that worked with the flu vaccine wouldn't work with other vaccine shortages. "At a point of crisis, there's going to be more selfishness," said Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine.

In the second report, University of Michigan researchers found that health insurance doesn't always cover immunizations for children and adults, and this may contribute to the low U.S. immunization rates. According to the report, some 5 million privately insured children and 36 million privately insured adults are not covered for immunizations.

According to the survey of 995 adults, 78 percent said they'd be willing to pay more to have their children covered for vaccinations.

"If given the option, people with private health insurance would opt to pay $3 to $6 more per month in premiums in order to have a guarantee of immediate coverage for newly recommended vaccines," said lead researcher Dr. Matthew M. Davis, an assistant professor of pediatrics, internal medicine, and public policy.

Davis noted that new childhood vaccines are introduced almost yearly and are becoming more expensive. "Now we have a situation where access to vaccines is not equitable," he said.

To improve this situation, people should be given the chance to increase their insurance premiums, Davis said. "That seems to be a workable option for the majority of the people we surveyed," he said.

NYU's Siegel believes the federal government should be the sole supplier of vaccines. "That's the way it works in every other country," he said. "The government should ensure a certain number of vaccines per year are made. Those should be distributed to physicians who should determine who should get them."

In the third study, researchers looked at the business of making pediatric vaccines and found that the vaccine industry in the United States is rapidly moving to single suppliers for each type of vaccine.

"It is almost inevitable, given the cost and demand conditions in the market," said co-author Patricia Danzon, the Celia Moh Professor of Health Care Systems at the Wharton School of Management, University of Pennsylvania.

Siegel believes that, regardless of how vaccines are manufactured, the federal government should be the sole distributor. "The government needs to be the middleman in vaccines, the way that it is in Europe," he said. "We have to ensure that we subsidize vaccines so that manufacturers can afford to make them, so we have the supply we need."

Dr. David L. Katz, an associate clinical professor of public health and director of the Prevention Research Center at Yale University School of Medicine, agrees that the federal government needs to be involved in buying and distributing vaccines. "It might prove less costly to make vaccine development and stockpiling a responsibility of federal agencies," he said.

"One thing is clear," Katz added. "Our current policies regarding vaccine development, storage, and provision are vulnerable to failure. Given the vital contribution of immunization to the public health, this aspect of our health-care system is itself in urgent need of therapeutic attention, and long-term care."

More information

The U.S. Centers for Disease Control and Prevention can tell you more about vaccinations.

SOURCES: Patricia Danzon, Ph.D., Celia Moh Professor of Health Care Systems, Wharton School of Management, University of Pennsylvania, Philadelphia; Matthew M. Davis, M.D., assistant professor of pediatrics, internal medicine, and public policy, University of Michigan, Ann Arbor; Robert J. Blendon, Ph.D., professor of health policy and political analysis, Harvard School of Public Health, Boston; Marc Siegel, M.D., associate professor of medicine, New York University School of Medicine, New York City; David L. Katz, M.D., M.P.H., associate clinical professor of public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; May/June, 2005, Health Affairs
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