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BL Fisher Note:

 In this article about flu vaccine uptake in America, a CDC spokesman says: “ We must increase demand to increase the supply,” said Dennis J. O'Mara, CDC associate director for adult immunization. “Companies are not going to produce vaccine they can't sell.”

  What is wrong with this picture? Why can't the free market system be allowed to work with vaccines just like it works with any other product bought and sold in America? The people know what they want. The vaccine industry ought to produce exactly what the people are demanding and the government should stay out of the business of drumming up business for industry.

http://www.ama-assn.org/sci-pubs/amnews/pick_03/hlsb0616.htm

AMERICAN MEDICAL NEWS

Flu vaccine supply ample, demand lagging

Public health questions persist, ranging from the number of vaccine manufacturers to how well matched the vaccine will be to the upcoming season's active strains. By Victoria Stagg Elliott, AMNews staff. June 16, 2003.

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There's good news on the horizon regarding the upcoming flu season -- and some work to be done, too. Despite the loss of one of the three manufacturers of flu vaccine and a reduction in the number of doses believed to be available this fall, public health officials and other vaccine experts doubt that this year's supply will be marred by the delays and shortages that characterized recent flu seasons.

Wyeth announced its exit from the injectable flu vaccine market in November 2002. But the remaining two manufacturers, Aventis Pasteur and Powderject Vaccines Inc., vowed to increase production to meet demand.

Public health officials estimate that 80 million to 85 million doses will be available for the coming season. They do not expect shortages or delays because last year the three companies manufactured more than 95 million doses. Only about 80 million doses made it to patients. “We are far, far from our Healthy People 2010 goals of vaccinating 90% of the elderly and 60% of younger people with risk factors,” said Walt Orenstein, MD, MPH, director of the CDC's National Immunization Project. 80 million to 85 million doses of flu vaccine will be available this season, down from 95 million last year.

This situation represents both the success and the failure of the National Influenza Vaccine Summit sponsored by the American Medical Association and the Centers for Disease Control and Prevention. The annual event, held last month in Chicago, has gathered an increasing number of stakeholders, including flu vaccine manufacturers, doctors, medical societies, distributors and mass vaccinators.

Meeting organizers say it has successfully increased communication between key players, thereby increasing vaccine supply and improving stability. It has not, however, resulted in increased demand among the general public, where interest has remained stubbornly flat. “We must increase demand to increase the supply,” said Dennis J. O'Mara, CDC associate director for adult immunization. “Companies are not going to produce vaccine they can't sell.”

Flu vaccine experts do hope that several new developments will improve the number of consumers who want it and the number of physicians willing to provide it. Medicare reimbursement rates for administration of the vaccine have nearly doubled.

An intranasal vaccine may come on the market this season and may be more accessible than the shot. Although the FDA has not approved the product, most connected to the situation believe that is imminent.

It is expected to be approved for healthy individuals between 4 and 49. As such, it likely will not help the elderly or those with medical conditions that may turn flu into a killer, but could improve vaccination rates among health care workers and others who care for high-risk people.

Medicare reimbursement for flu shots has nearly doubled since last year. “Inhaled influenza vaccine will be a tremendous advance once it's licensed,” said Eddy Bresnitz, MD, assistant commissioner for the New Jersey Dept. of Health.

The CDC's Advisory Committee on Immunization Practice has also expanded the number of people who can be targeted with early vaccination campaigns, but is sticking to the two-tiered system that attempts to ration vaccine for those who most need it during times of shortage and delay.

The two-tiered system remains controversial, particularly in years without shortages. Some vaccine providers, particularly those targeting workplaces and other nonmedical settings, are warning that the two-tiered system undermines the overall mission.

Specifically, they say waiting to hold these kinds of clinics during seasons when there is no supply crisis does not allow enough time for widescale vaccinations. And offering early workplace clinics that target only high-risk individuals is not practical because of privacy considerations.

“Last year, we were trapped with vaccine that we couldn't give,” said Roslyn Stone, chief operating officer of Corporate Wellness Inc., a national occupational health care provider. “We have no success giving vaccines in December and January. We need to roll back the start date if we have plenty of vaccine.”

Possible bumps in the road

Although most experts expect the coming vaccination season to be smooth, there are some long-term concerns, mostly because of the limited number of manufacturers involved. “If something goes wrong, we could be in a lot of trouble,” said J.R. Ransom, senior analyst for immunizations at the National Assn. of County and City Health Officials. There are also some indications that, despite a stable vaccine supply, the flu season may be bumpy. The strains selected in March for this year's vaccine were, for the first time in a long time, the same as the previous year.

A month later, public health officials noted a new strain circulating and raised the possibility that the  vaccine may not be as good a match as in previous years. Even in the best years, the vaccine never provides 100% protection. And, while the new strain may never prove to be a serious threat

-- it might.

“That shouldn't stop us in any way from proceeding to immunize,” said Herb Young, MD, director of the scientific activities division at the American Academy of Family Physicians. “The complication this year is the possibility that we could see disease caused by a strain that was not included in what was selected. That's always a possibility.”

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