In U.S., flu shots too short

Patients and doctors frustrated by supply amid great demand


As Americans find they are unable to get the flu shots they want for the second year in a row, officials said yesterday that high demand and the government's inability to prevent shortages continue to frustrate patients and doctors alike.

People apparently are worried that avian flu, an unrelated strain, could lead to a pandemic and do not want to miss a shot this fall, as many did last year amid a broader flu vaccine shortage, said Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention. Her mother is eager for a shot that won't be available until late this month, she said.

Patrick M. Libbey of the National Association of County and City Health Officials said the lack of a flu vaccine tracking system makes it tough to tell what shipments are going to large for-profit vaccinators or to small clinics.

Doctors across the country have run short of flu vaccine.

"It's a national problem," said Larry S. Fields, president of the American Academy of Family Physicians. His five-physician family practice in Ashland, Ky., ordered 1,000 doses but had received only about 300 as of yesterday.

Initially, he said, the practice got none and had to hustle to buy excess from a Louisville hospital.

Gerberding said about 71 million doses had been sent to distributors but had not necessarily been administered. The country is on track by month's end to receive up to 83 million doses of influenza vaccine, which is formulated anew each year to target a specific strain of the virus and shipped as it is made. If that mark is exceeded, it would be a record year for U.S. flu vaccine distribution, she said.

`Plenty of time'

In the meantime, Gerberding advises people to remain patient and to call physicians back to see if vaccine has arrived. She said she told her mother that.

Because flu season is off to a slow start nationally, and because it generally peaks in January or February, there is plenty of time for a shot to take effect, Gerberding said.

"States are showing sporadic or no flu activity," she said at a news briefing yesterday. "That's a good thing, because it gives us time to get the vaccine out there."

Still, Gerberding acknowledged that the free-market system for distributing flu vaccine has led to complaints that some doctors offices have few or no flu shots to give.

"This situation is a market distribution problem that is difficult to fix from a government perspective," she said.

The federal government has no direct control over where vaccine is shipped. It is not a large purchaser of flu vaccine, though it is trying to stockpile about 800,000 doses to distribute as needed to shortage-plagued areas. The government has asked distributors to ship equitably to avoid geographic disparities.

Outlets ranging from local health departments to Maxim Health Systems and Passport Health, two for-profit providers, placed their orders long ago but have been getting shipments a little at a time.

As of yesterday, with only one influenza case confirmed in Maryland, 19 of the state's 24 local health departments had received all of the vaccine they ordered, said Greg Reed, program manager for the Maryland Center for Immunization. The remaining five had gotten some, and should receive the full complement by the end of the month, he said.

The state was working with local health departments to move vaccine around as needed. None has run out, he said.

Spot shortages

Yet, here and elsewhere, people unable to find -- and doctors unable to provide -- flu shots remained frustrated yesterday. Shortages, reported early on in Arizona, were still a problem this week in Rochester, N.Y., Salt Lake City and in the Baltimore area.

Vivian Peshkin, 76, of Colonial Village in Baltimore County, said she will try to get a shot at a store clinic after her doctor could not provide one during an appointment Monday.

"I said, `Now I'm ready for the flu shot,' and he said, `I don't have one,'" Peshkin recalled

Lee Starkey, 72, of Stoneleigh, had a similar experience. His physician did not have any vaccine last year and was frustrated by delivery delays this year.

"The delivery date was so far into December, he felt at that point it was so late it wasn't worth ordering," Starkey said.

Starkey, a retired Baltimore County consultant, ended up standing in line for two hours to get a shot at Giant, before Maxim closed that flu clinic.

In the Rochester area, about 60,000 flu shots are administered in a normal year. But many large flu clinics have been suspended, pending the arrival of more vaccine, said John Ricci, a spokesman for the Monroe County Health Department.

The Health Department vaccinated about 150 people in inner-city Rochester yesterday. But with flu vaccine in short supply, some private providers and public health departments are avoiding major immunization efforts for now.

"You can't go to a public clinic with a couple of hundred doses, because you don't know if 1,500 people might show up," Ricci said. "You really need a pretty good cache."

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