Chills of vaccine rationing
Rationing is not something Americans are used to, but we have no choice when it comes to this year's flu shots. Half of our vaccine supply was abruptly wiped out with the British authorities' shutdown last week of Chiron's vaccine manufacturing plant in Liverpool, England. The action was taken for safety reasons but means that the 48 million doses ready for delivery in October will not make it to our shores. The Centers for Disease Control and Prevention's annual health message, calling for most Americans to get a yearly flu shot, promptly morphed into a public service plea for the able bodied to hold off and move to the back of the vaccine line--or better yet, stay away altogether.
For most people who catch the ever-mutating bug, flu is a miserable week of fever, chills, headache, sore throat, nasal congestion, and muscle aches. But for some, it carries mortal risk: Roughly 100,000 people require hospitalization, and some 30,000 die. Since most of that risk is borne by the very young, the elderly, and the chronically ill, the CDC has defined the priority groups for vaccination--those over age 65, children between 6 months and 2 years of age, and any person afflicted with chronic illnesses like asthma or a depressed immune system. First dibs on the rationed vaccine also go to healthcare workers, pregnant women, and those caring for infants.
Does this mean that the ranks of the rationed-out will get the flu? Not necessarily. To catch the flu, you have to suck in someone else's respiratory secretions, either by inhaling cough or sneeze droplets in the air or transmitting the virus to your mouth or nose through your own virus-soiled hands. The answer is to be fastidious: Keep your upper-airway secretions to yourself, and avoid those who don't. Make a habit of hand washing; carry hankies and alcohol hand wipes in your pocket; and in honor of the flu season suspend those sociable kiss-on-the-cheek greetings or sips from the same goblet. Indeed, if less vaccine brings better health manners, that's good.
But there's not much good in the present vaccine mess. Losing half of our nation's flu shots overnight is stark evidence of the vulnerability of our vaccine enterprise. Nagging weaknesses in supply are not new. For years we have been flirting with shortages, and just last year we knowingly used a vaccine that failed to match the circulating flu strain. We've swallowed these problems because we're locked into a slow and cumbersome 60-year-old method based on culturing virus in hens' eggs. There is faster and better technology, using DNA engineering and tissue culture; however, financial and liability hurdles, limited interest from pharmaceutical houses, and concerns about years of testing needed to make change have kept us mired in an antiquated system.
Vulnerable. We as a society are obliged to take a hard look at these vaccine vulnerabilities. Our government is now in the midst of planning for what is believed to be a long-overdue pandemic--the big one. The kind that grimly swept the globe back in 1918, killing millions, young and old, healthy and sick. Pandemics happen when an especially lethal flu strain emerges from domestic animals like birds or swine and then mutates into a human transmissible form. The World Health Organization has been tracking the new and dangerous avian flu known as H5N1 that has decimated millions of birds throughout Asia--and killed more than three quarters of the humans who contracted it from sick birds. Pandemic concern heightened two weeks ago when Thailand announced the first possible case of human-to-human transmission. If this means H5N1 has transformed into a contagious human strain, we will see a mad rush to get the hens' eggs ready. But public health officials are already resigned to the fact that there simply won't be enough pandemic vaccine early on, and that means big-league rationing. At a time when every citizen faces a mortal threat, who then gets the precious lifesaving medicine?
In assessing the current vaccine shortage, CDC' s director, Julie Gerberding, said, "Take a deep breath." She meant, there is no crisis since we have enough for those who really need the stuff. But were this to be a time of pandemic, denying lifesaving vaccines arbitrarily to millions of Americans--because we have been unwilling to apply the fruits of our own modern biological sciences to vaccine readiness--would become the biggest public health failure in the history of the nation. Everyone should hyperventilate over that prospect.
This story appears in the October 18, 2004 print edition of U.S. News & World Report.