Companies struggling to get H1N1 vaccine to US
Tue Oct 27, 2009 6:28pm EDT
* Senators ask why HHS made promises
* Novartis, CSL working to improve production
* Vaccine shortage could drive demand
By Maggie Fox, Health and Science Editor
WASHINGTON, Oct 27 (Reuters) - The U.S. government may end up throwing away unused doses of swine flu vaccine if people cannot get it soon enough, the director of the U.S. Centers for Disease Control and Prevention said on Tuesday.
Members of Congress questioned whether federal officials were too rosy in their estimates of how much vaccine would be available and when, and companies said they were still struggling to produce immunizations against H1N1.
CDC director Dr. Thomas Frieden said 22.4 million doses were now available to states, which can get them a day after they order them.
"It's quite likely that that too little vaccine is one of the things that's making people more interested in getting vaccinated, frankly," Frieden told reporters.
"We think it will get easier to find vaccine in the weeks that come."
Many states and cities say they have received about one-tenth as much vaccine as they originally had expected by this time. Frieden said the delays may discourage people who are lining up for vaccine.
"It is likely also as we produce more vaccine and as both people are given the opportunity to get vaccinated, and as disease maybe wanes in the future, we will have significant amounts of vaccine that can't be used," Frieden said.
"One of the messages for states, localities and health providers is not to reserve vaccine that they have available, to give it out as soon as it comes in, because more is on the way."
In September, U.S. officials said 40 million vaccine doses would be available by the end of October and they estimated 20 million doses a week would be delivered, with a goal of 250 million doses by the end of flu season in March or April.
Maine Republican Senator Susan Collins asked why the estimates were so far off.
"It now appears that much of the vaccine could arrive only after many people have already been infected with H1N1," she said in a letter to Health and Human Services Secretary Kathleen Sebelius, released late on Monday.
"It seems that HHS gave its assurance of sufficient supply in August without adequate information to make such a commitment."
Connecticut independent Senator Joseph Lieberman weighed in on Tuesday.
"Unfortunately, these missteps in estimating available doses of H1N1vaccine have effects beyond just growing public frustration; they have the potential to critically undermine our vaccine distribution efforts, which depend on accurate estimates of vaccine availability," he said.
But HHS spokeswoman Jenny Backus said the agency was simply passing on information as it became available.
"We have been very clear and open and told the American people what we know when we know it," she said in a telephone interview.
"We have passed on the manufacturing estimates, and as they have changed, we have conveyed the information to the American people, too."
Vaccine makers and government researchers alike have complained about the reliance on outdated and unpredictable vaccine manufacturing methods that use chicken eggs.
The virus has spread much faster than vaccine can be delivered, and Frieden estimates that millions of Americans have been infected. While not especially deadly, it is affecting young adults and children who normally escape the most serious consequences of seasonal flu.
L.A. County free H1N1 vaccine clinics overwhelmed
Immediately swamped by patients, they haven't been able to monitor whether those receiving the vaccines were at the top of the federal priority list.
Los Angeles County's free H1N1 flu clinics opened last week amid public health officials' promises to aggressively vaccinate people at highest risk, especially the uninsured. Instead, overwhelmed clinic staff began vaccinating many people who were not supposed to be first in line for protection, officials said Tuesday.
"We thought it was important to get to as many people as quickly as possible," said Dr. Jonathan E. Fielding, the county's director of public health. "We were assuming that the private sector was going to be getting a lot more vaccine a lot faster than they did."
Fielding conceded that county officials failed to conserve vaccine supplies early on, unwilling to turn away those who had traveled and waited in line. By Tuesday, they faced a vaccine shortage, with only enough doses to stay open through Nov. 4 instead of the planned Nov. 8.
"How do those people feel when they came a long way and in many cases are part of a family?" Fielding said. "What do we say -- we'll do your children but we won't do you?"
In recent days as demand for the scarce vaccines has increased and anxiety has grown, officials with the Centers for Disease Control and Prevention say many public health clinics have reported needing to intensify screening to take care of the most vulnerable first.
"They're adapting and making rolling changes with vaccine availability," said CDC spokesman Joe Quimby.
State and federal officials have recommended, but cannot mandate, that local governments vaccinate federal priority groups first. Those groups include: pregnant women, people living with or caring for infants under 6 months old, emergency medical services personnel and healthcare workers, children and young adults ages 6 months to 24, and people 25 to 64 years old with chronic medical conditions such as heart or lung disease, asthma, diabetes or weakened immune systems.
In L.A. County an estimated 5.5 million people fall into priority categories, Fielding said. Only about 50,000 people have been vaccinated since the county's first clinic opened Friday. County staff -- busy trying to handle the growing lines -- have not tracked how many of those vaccinated were among priority groups, Fielding said.
At Los Angeles area clinics, health officials said many in the long lines had insurance but reported that their personal doctors did not have the vaccine. Others had traveled from nearby counties.
On Saturday, staff had to close a drive-through clinic in Redondo Beach after being swamped. Staff at county clinics were vaccinating 300 people an hour, Fielding said.
Fielding, who personally screened some in line at a Compton clinic Tuesday, promised stricter guidelines going forward. He blamed the local shortage on national delays in manufacturing the vaccine and a surge in demand after President Obama's Saturday declaration of a national H1N1 flu emergency.
So far, clinic staff are continuing to vaccinate eligible people from neighboring counties that have yet to open free clinics. If their ranks increase, however, they may be turned away, Fielding said.
"It's hard to know what the balance is," he said.
Orange County public health officials, who plan to open their first two public clinics Saturday, will restrict vaccines to healthy children 2 to 9 years old and healthy adults age 49 and under caring for infants 6 months old and younger. Those who do not qualify will be turned away, according to Deanne Thompson, spokeswoman for the Orange County Health Care Agency. They have received about 10,000 vaccines for public clinics, she said.
"There is a limited supply and we have to make sure it gets to those who need it the most," Thompson said.
With so little vaccine on hand, many public health officials are struggling to ensure that those most in need are helped first.
In Portland, Ore., public health officials heightened screening after clinic staff were mobbed last Thursday by 1,200 people seeking the vaccine. A spokeswoman said they ended up vaccinating some who were ineligible while denying others who qualified.
In Phoenix last weekend, county health officials restricted the 50,000 vaccines available at free clinics to children up to age 5, children with underlying health conditions, caregivers for children younger than 6 months old and healthcare workers.
In Las Vegas, where free clinics have been distributing 600 vaccines an hour, officials this week were distributing only nasal spray vaccines, and limiting them to those ages 2 to 24, healthcare workers with patient contact and caregivers of children younger than 6 months old.
Clinic staff members question those waiting in line, but as in Los Angeles, they rely on people to be honest about whether they are eligible.
"We are kind of going on the honor system," spokeswoman Stephanie Bethel said.
Federal officials have distributed the vaccines to the states in proportion to population. They were expected to have supplied 40 million vaccines by this week, but manufacturing delays reduced the supply to 11 million, Fielding said. L.A. County officials were expecting a shipment of 94,000 vaccines this week, but it was unclear how much more will be shipped in coming weeks.
Fielding cautioned that as vaccine supplies dwindle, clinic staff may vaccinate only those in the two groups considered at greatest risk: pregnant women and caregivers for children younger than 6 months old. Clinics that run out of vaccines will close early, he said, and new clinics may be canceled if vaccine shipments are delayed.