Vaccine allotted by risk for flu

CDC says sole manufacturer reroutes half of remaining shots

Md., city unsure how much they will get

VA hospitals, state agencies, pediatricians are top priority

October 13, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

In the first phase of a plan to redistribute flu vaccine, the nation's sole remaining provider will send more than half of its 22.4 million unshipped doses to the places that need it most: state health departments, pediatricians' offices, nursing homes and hospitals.

Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention, acknowledged yesterday that the plan to reallocate supplies from Aventis Pasteur will not please everyone - including providers who end up with unfilled or scaled-back orders.

But she said it is public health officials' best effort to distribute the scarce vaccine equitably among the highest-priority patients.

"We think that this is the first step toward doing everything we can to protect all Americans from flu this year," she said. "We're going first to the people who need this vaccine the most and where we can logically predict the greatest number of at-risk people."

Of the 22.4 million doses remaining in Aventis' stock, 14.2 million will be directed to patients at greatest risk of complications from the flu: infants, the elderly, people with chronic medical conditions and health care workers.

VA medical centers, the Defense Department and state health agencies that had ordered their entire vaccine supply from Chiron Corp. - the California-based company whose manufacturing problems prompted the current shortage - are among those who will receive Aventis vaccine in the first wave of redistribution.

Providers in the Vaccines for Children program, which offers free immunizations to youngsters on Medicaid or uninsured, will also have top priority.

Federal health officials expect to work with Aventis to shift 8.2 million unallocated doses to providers in areas of the country hardest hit by influenza. Of that, 4.5 million doses have been committed to a CDC stockpile.

"We will have great flexibility to move that vaccine around," said Gerberding. "This is a very important need for us to have flexibility to adjust and move things as needs emerge."

She said the public health agency also has a supply of Tamiflu - an antiviral drug used to treat and, in some cases, prevent the flu on a short-term basis. It plans to order up to 5 million courses of treatment of rimantadine, another antiviral medication.

Damian Braga, president of Aventis Pasteur U.S., said yesterday that the bulk of the doses that had been ordered but not shipped - nearly 12 million - were already headed to places with patients the CDC considers high-risk.

He urged customers to be patient and understanding: "We're hoping that with some cooperation from our customers that the actual customer disruption ... will be at a minimum."

The CDC will monitor, county by county, the locations where the vaccine is being sent and the number of at-risk patients in each jurisdiction. The federal agency also will step up its disease surveillance once the flu season begins. Influenza "hot spots" - such as Colorado last year - are likely to get additional doses as needed.

Aventis will continue to ship vaccine doses into December, Braga said.

Maryland's health department has not yet heard whether Aventis will ship more vaccine here in the coming weeks and months. Greg Reed, program manager for the Maryland Center for Immunization, said that, of the 59,000 general-use doses that state and local health agencies ordered from Aventis, only about 38,000 had been sent. Of the 105,000 doses those departments purchased for the Vaccines for Children program, just half are in hand.

"We are trying to follow up with the manufacturer," said Karen Black, a Department of Health and Mental Hygiene spokeswoman. "It's a very fluid situation. And we're not going to know specifically the quantities until, probably, as we move further along into the season."

Baltimore's health commissioner, Dr. Peter L. Beilenson, said he isn't sure, given the CDC's redistribution plan, whether his department will get its full order from Aventis.

Only 500 of the 2,000 doses he initially purchased have been sent. The city immunized 120 people before the shortage came to light, leaving Baltimore with just 380 doses.

"We're trying to make sure that the sickest folks get these vaccines," said Beilenson, who canceled the city's remaining flu clinics until further notice.

Following federal and state guidelines, Beilenson has encouraged doctors and pharmacies, including those at Giant and Safeway, to give flu shots to only people in high-risk categories. He said employers who hold flu clinics should also administer the vaccine only to at-risk workers - and turn over unused doses to officials.

So far, the voluntary rationing urged by the CDC has been reliant on the honor code. "We have used this strategy before with significant success," said Gerberding, "and we're so far seeing very good evidence that it's working this time out, too."

Still, reports of those with the vaccine in hand charging exorbitant amounts for it continued to mount. Kansas' attorney general filed suit yesterday against a distributor accused of trying to sell the vaccine for $900 a vial. Before the shortage, it reportedly was charging $85.

"Thank you to all the people who are cooperating so beautifully and shame on the people" who aren't, said Gerberding. "There is no room for this kind of behavior in an environment where we need to pull together as a country to protect our vulnerable populations."

Sun staff writer Dennis O'Brien contributed to this article.

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