Shortages hamper children's vaccination

Doctors fear U.S. could lose ground in fighting illnesses

March 23, 2002|By Jonathan Bor | Jonathan Bor,SUN STAFF

Vaccine shortages are forcing pediatricians to delay giving shots against diseases from tetanus to whooping cough, raising concerns that the nation could lose ground in the fight against childhood illnesses.

The trouble started last summer when doctors had difficulty replenishing supplies of tetanus vaccine. Production problems have since triggered shortages of immunizations against chickenpox, diphtheria, whooping cough, measles, mumps, German measles and pneumococcal disease.

For now, pediatricians say the shortages have bedeviled staffers who have had to keep track of patients who did not get shots during scheduled visits, and parents who have had to bring their youngsters back to make up missed shots.

Doctors warn that the shortages could have serious repercussions if they continue over the long term.

"If children don't get them on time, immunizations missed may mean immunizations not given," said Dr. Robert Ancona, pediatrics director at St. Joseph Medical Center in Towson.

Ancona said children who delay getting shots against measles and other serious illnesses face little short-term risk because wide-scale immunizations - a public health success of the past quarter-century - have driven the diseases to all-time lows. But if the shortages persist, the infections could gain footholds again.

Dr. Daniel Levy, an Owings Mills pediatrician, said he fears that parents might begin to take immunizations less seriously if they see that doctors cannot supply them.

"It's a credibility issue," said Levy, who is also a spokesman for the American Academy of Pediatrics. "We've been working so hard to convince people that immunizations are an important thing to protect children. But if we don't have them, how seriously will people take us?"

The shortages have numerous causes. Many companies, finding low profit margins in vaccines, have stopped making them. Since the 1960s, the number of companies making pediatric vaccines has shrunk from more than 30 to four - Aventis Pasteur, GlaxoSmith- Kline, Merck and Wyeth-Ayerst Labs - in part through corporate mergers, but also because companies are turning to more profitable drugs.

Now, each pediatric vaccine is made by one or, at most, two companies, meaning that production problems at any one factory can cripple the nation's supply.

A similar problem has affected vaccines used primarily by adults. A federal shutdown of the only factory making anthrax vaccine cut off the nation's supply for four years. When a company decided last year to stop making flu vaccine, many people were unable to get vaccinated before flu season.

Gillian Woollett, associate vice president of biologics for the Pharmaceutical Research and Manufacturers Association, said companies cannot command a high price for vaccines because society does not fear the diseases they prevent.

"Most people don't see these diseases," she said. "They don't see the value of the products." Also, federal and state governments are the largest consumers of pediatric vaccines, and they buy them at deep discounts.

A recent recommendation by a federal advisory group that companies stop using a mercury-based preservative in vaccines also led to a slowdown in production. Some companies retooled factories to produce single-dose vials that didn't need preservatives; others decided to get out of the business.

In a crackdown on production practices, the U.S. Food and Drug Administration has forced some companies to upgrade their factories. Plants have been forced to stop production until the necessary improvements are made.

Greg Reed, who runs the immunization program for the Maryland Department of Health and Mental Hygiene, said doctors are having their greatest difficulty obtaining chickenpox vaccine and a combination vaccine that protects against diphtheria, tetanus and whooping cough.

The combination vaccine, given to infants, is produced by Aventis Pasteur and GlaxoSmithKline. Those companies have indicated that the delays will ease within the next few months, Reed said.

But continued shortages of the tetanus component have forced private doctors to give up supplying tetanus booster shots, which were previously given to adolescents to keep immunity strong. Now, patients are being told to get boosters at emergency rooms - and only if they step on a rusty nail or suffer a dirty cut.

Reed said local health departments, which maintain vaccine reserves, will help children get vaccines needed to enter school. Dr. Peter L. Beilenson, Baltimore's health commissioner, said he does not intend to relax rules that deny school admission to children who are not up to date on vaccines.

"If it truly becomes an issue this summer, we will hold clinics," Beilenson said. "We've fought too hard to get up to where we are now, at 99.9 percent compliance."

Dr. Felix Kauffman, a Towson pediatrician, said the shortages have caused inconvenience and frustration but have not placed patients at risk. "There is sufficient flexibility in immunization schedules that we've been able to work around the shortages," he said. Children can miss a scheduled dose as long as parents bring them back when supplies are in, he said.

Fran Lessans, president of Passport Health, a Baltimore-based company that runs 80 vaccination and travel clinics nationwide, said she has coped with the shortages in a way that private doctors cannot. "I've overbought," she said, explaining that she buys large stocks when shortages ease.

At the pharmaceutical trade group, Woollett predicted that vaccine shortages will continue, even if particular problems ease.

"Last year we had a manufacturer pull out of tetanus, and one pulled out of flu," she said. "Once you've lost that capacity, you can't switch it on again."

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