Season's shortage of flu vaccine taught officials lessons for future

Health Department chief, staff worked to minimize impact on residents

April 03, 2005|By Cassandra A. Fortin | Cassandra A. Fortin,SPECIAL TO THE SUN

Harford County's chief health officer says officials learned some lessons from this season's flu vaccine shortage.

According to Dr. Andrew Bernstein, head of the department, the vaccine deficit gave Health Department leaders a chance to combine resources and bridge a communication gap. Additionally, it forced the initiation of a plan for handling what Bernstein said will be inevitable future shortages.

The vaccine crisis started in October, with a memo stating that the Centers for Disease Control and Prevention had received word from Chiron Corp. that none of its inactivated vaccines would be available for the 2004-2005 flu season.

Bonnie Herbert, a CDC press officer, said this cut available flu vaccines ordered in the United States in half.

"Chiron was supposed to produce 50 million vaccines, and Aventis-Pasteur was to produce the remainder," Herbert said. "When Chiron couldn't produce their portion, we were 50 million short. We were able to come up with another 11 million, but we were still 39 million short."

When word came from the Maryland Department of Health and Mental Hygiene advising the 24 local health departments of the shortage, the first reaction was one of bewilderment and concern.

"When we first heard about the shortage, we didn't know who got the vaccines, or where they went. We have 350 physicians with addresses in Harford County," Bernstein said.

Bernstein said his staff worked to minimize the effects of the shortage. They applied the national incident management system approach, Bernstein said, adding that using this approach - normally used for natural disasters - was a good choice for dealing with the crisis.

"We opened an emergency operations center and brought health officials in to address the issue," Bernstein said. "We set up clinics, and visited sites to assess the traffic flow. So we knew what the traffic flow at each facility could be and what we would need to make it run smoothly."

In addition to running the shot clinics efficiently, Bernstein said he made educating people key to ensuring that high-risk patients understood and received the vaccination.

"We created a flu hot line," Bernstein said. "We had 300 to 500 calls a day. The hot line operators told people who was eligible, where they could get a shot and what to do if they could not get a shot. We wanted everyone to have good information."

Bernstein said misconceptions about the Health Department during the crisis were surprising.

"One thing that really surprised me was people thinking we had more control over the situation than we did," Bernstein said.

"We got a lot of complaints about places or doctors giving out shots to anyone whether or not they were high risk," he said. "They would ask me, `Why are they getting shots, and I'm not?' or `Why do they have shots, and my doctor doesn't?' We had to explain that there are no laws saying anyone had to act on the recommendations of the CDC; we were all encouraged to do so."

After going through the crisis this season, Bernstein said he has no doubt that shortages will occur again with or without Chiron.

"The flu vaccine shortages aren't always caused by a shortage in manufacturing," Bernstein said. "This year they're using the California A virus. I've heard that California A doesn't grow well in the egg. This could create a low yield if no one can get it to grow. We have to always watch out for all the possibilities when it comes to this vaccine. We really won't know how it grew until about September." Despite his concerns with vaccine shortages, he feels better prepared and said he plans to do some things differently.

"We're deciding now what to order for next season," Bernstein said. "We'll order at least what we had this season and maybe more. We may hold a stakeholders meeting in the summer. We want to try to get information to the senior day care centers about the shots. We did an article in the local paper and explained it to people, and still they said they didn't know they were eligible. I know of some providers who said it was a mess, and they won't offer the shots at all."

Bernstein said his department doesn't get funding for the shots but feels a duty to offer them. "We want to be sure that we help people get what they need," he said. "We make sure we don't create barriers for people not to get them. We charge $10 per shot. If someone can't afford that cost, we offer a sliding scale, or they pay nothing. We make sure those who need it can get it."

Bernstein said incidents during flu season this year show the desperation people feel when they think they won't get their shot.

"I did traffic duty at the event with 2,500 people getting vaccinated," Bernstein said. "I told one lady to stop so I could let traffic out, and she thought I wasn't going to let her get her shot, and she ran over my foot. Another lady told me she was going to get a shot, or she would go home and get her shotgun and make sure she did."

Vickie Bands, director of community outreach occupational health at Upper Chesapeake Health, says her agency still has flu vaccine and doctors continue to write prescriptions for the shots.

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