TUESDAY, Dec. 9, 2003 (HealthDayNews) -- U.S. health officials scrambling to meet a shortage of flu vaccine acknowledged Tuesday that the crisis is the result of a failure of the laws of supply and demand.
And while existing doses are expected to be distributed to places that need them the most, one vaccine maker announced Tuesday that it would try to make available an additional 400,000 doses.
Chiron Corp., a California-based biotech firm that is the world's second largest vaccine maker, said it had sold 38 million doses in the United States for the 2003-04 flu season. The 400,000 additional vaccines are "already manufactured but not yet ready for distribution," said Alison Marquiss, a spokeswoman for Chiron. The doses are manufactured in Europe, she added.
As of the end of last week, 13 states were reporting widespread flu activity but the illness appears to have also touched most other states.
Western states have been particularly hard hit, with several flu deaths in Colorado, among others. And Oklahoma health officials told the Associated Press that the influenza outbreak there had reached epidemic proportions with at least six people dead. The state's health officials predict they will be out of vaccine by the end of the week.
Only two jurisdictions -- Washington, D.C., and Massachusetts -- have not yet reported flu activity, although that could change at any moment, health officials said.
"It's not going to surprise us if we see more cases than average this year," Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said at a Tuesday press conference. "And because the predominant strain historically has been associated with more severe disease or more hospitalizations, it's not going to be surprising if that's the case."
There is no guarantee that the flu will continue unabated. In four of the last 19 years, the heaviest activity was reported in December and waned thereafter, according to the CDC.
"The good news is that we've probably vaccinated more people than we ever have before, but the unfortunate situation is that there are still localized shortages," Gerberding said. "The main concern that we're facing at CDC is the gap between the demand for flu vaccine in the context of this outbreak and the supply of influenza vaccine."
Manufacturers this year created about 83 million doses of the vaccine, 4 million to 5 million of which are in the form of FluMist (recommended only for healthy people aged 5 to 49) and another 4 million to 5 million for children 6 months to 23 months. That leaves 73 million doses for adult immunization, most of which have been distributed.
Flu vaccine is manufactured exclusively by private companies who base the current year's supply on previous years' demand. While 185 million people are included in the government's guidelines of who should be vaccinated, usually no more than 70 or 75 million people get the shot.
Last year, the vaccine makers produced 95 million doses, 12 million of which went unused and had to be thrown away -- hence this year's decision to make only 83 million doses.
"That was a pretty high water mark," Gerberding said. "More people have stepped up to the plate to get the vaccine, so the manufacturers' estimate of the appropriate amount of vaccine to make may have undershot the mark, and that is one of the consequences of having vaccine manufacturing occur in the private sector."
Because it is not possible to make more vaccine -- the process takes too long and would interfere with next year's production cycle -- health officials are having to come up with other stopgap measures.
According to Gerberding, state and local health agencies are assessing the availability of vaccine in their jurisdictions and developing plans to redistribute any surpluses to areas that need them most.
The CDC is also exploring the possibility of buying extra stock from both U.S. and European manufacturers. Aventis Pasteur, the biggest manufacturer, has a few doses left. The move for Chiron's extra stock from Britain would require approval from the U.S. Food and Drug Administration.
For long-term solutions, experts have been pressing for implementing new manufacturing methods (such as reverse genetics) that are faster, or having the government underwrite the cost of manufacturing extra vaccine. Neither strategy will do any good for the current flu season, however.
Complicating matters is the fact that this year's flu strain is not a precise match with the vaccine. "We think [the vaccine] offers cross-protection, but we won't know for several weeks how close that cross-protection is," Gerberding said.
Meanwhile, health officials are still recommending that high-risk people get vaccinated. That includes all people over the age of 50, residents of nursing homes and other long-term care facilities, adults and children over the age of 6 months who have chronic conditions, and others. Officials are not restricting vaccine access but, Gerberding said, "we want those with the highest risk to be the first to receive it."
FluMist is an option for healthy people with in the age guidelines. However, because this is a live vaccine, recipients should take care not to potentially expose anyone else after receiving it.
As for actually finding the vaccine, Gerberding recommended contacting your clinician to first of all determine if you actually need the vaccine. If you do and there is no vaccine available, he or she can contact local health agencies to find a supply.
"You need to recognize that you have to be persistent," Gerberding said. "Even if we even out supplies, some people who would like to receive the flu vaccine may not be able to get it."
After that, protect yourself by avoiding situations where you might be exposed to ill people and practice "respiratory hygiene," she added.
Most of the people who do get sick, Gerberding said, "are going to be annoyed by it but are not going to suffer major consequences."
More information
For more on influenza and this year's season, check out the CDC or the American Lung Association.
