HIV/AIDS & H1N1: NATAP — 5 mainstream articles about vaccine shortages (wsj, bloomberg, reuters, latimes, park nicollet minn health services) (0063)

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NATAP: H1N1 Vaccine Shortage Update

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here are five articles focusing on the shortage of H1N1 vaccine from the wall street journal, bloomberg, reuters, latimes and park nicollette minnesota health services news.

namaste

—rk


wall-street-journalSwine-Flu Update: Vaccine Shortage
wall street journal
Oct 26

The H1N1 flu is now widespread in 46 states — it’s as if we’re at the peak of the flu season, as this flu tracker shows. Yet as of Friday, only about 16 million doses of swine flu vaccine had been shipped to U.S. warehouses; officials had previously estimated that there would be 40 million doses by the end of October.

Some manufacturers, including Novartis and Sanofi-Aventis, initially saw a low yield from the seed strain of virus used to grow the vaccine, the WSJ notes. Another manufacturer, CSL, is based in Australia, and filled orders there before shipping to the U.S., the New York Times reports.

The supply is likely to grow rapidly as manufacturers get the kinks worked out. But the key question is how the flu will spread between now and the time — probably a few months from now — when there’s enough vaccine for everyone who wants it. “We expect this influenza will occur in waves,” the CDC chief said on Friday. “We can’t predict how high, how far, or how long the wave will go or when the next will come.”

Bonus Flu: President Obama on Saturday declared a national emergency for H1N1 flu. The main point officials seemed to be pushing on this front: This is just a way to make it easier for hospitals to set up off-site treatment centers, and it’s not really as bad as it sounds (a national emergency was also declared during the presidential inauguration, for example). Or, as a USA Today headline said, “‘National emergency’ for H1N1 no cause for alarm, experts say.”

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Bloomberg-News-logoSwine Flu Vaccine Scarcity Stirs Anger in U.S. Communities
bloomberg

Oct. 28 (Bloomberg) — San Diego health officials said that the county expected to run out of swine flu vaccine yesterday after receiving only 25 percent of the 411,000 doses anticipated for October, as reports of shortages nationwide mount.

New shipments may arrive “in the next week or two, we hope,” said Jose Alvarez, a spokesman for the San Diego CountyHealth and Human Services Agency. From New York, where October deliveries fell short by 400,000 doses, to Dallas and Phoenix, which have postponed mass vaccinations, to San Francisco, where one family clinic is fielding 400 calls a day, local officials are being pressured by parents for swine flu vaccine as the death toll for children in the U.S. reached 95.

The U.S. received 8.3 million more doses of H1N1 vaccine from drugmakers in the last week, bringing the total available for distribution to 22.4 million, said Thomas Frieden, director of the Centers for Disease Control and Prevention in Atlanta. The supply isn’t enough, he said in a call yesterday with reporters. Local officials and doctors agree.

“Some parents are very angry,” said Joanne Cox, associate chief of pediatrics at Children’s Hospital in Boston. “We have very high demand. The phones are ringing off the hook.”

Nicole Lurie, assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, said on Oct. 23 that the U.S. won’t get the 195 million doses it had planned for by the end of the year because of production delays at two drugmakers and one manufacturer’s failure to gain regulatory approval for its product.

Vaccine Suppliers

GlaxoSmithKline Plc and AstraZeneca Plc, both based in London, Sanofi-Aventis SA of Paris, Novartis AG in Basel, Switzerland, and CSL Ltd. of Melbourne, Australia, provide the bulk of the U.S. supply.

While the U.S. may receive 42 million doses from the drugmakers to distribute to states by mid-November, that is 8 million fewer than earlier U.S. estimates, Lurie said. Local health departments are already feeling the pinch.

San Diego received only 100,000 doses of the vaccine it was expecting this month, Alvarez said yesterday. “As of this morning, we were running extremely low” after about 16,500 doses were distributed through county clinics over the weekend, he said.

Dallas County, in Texas, planned for a mass vaccination effort on Oct. 24. It had to cancel because it didn’t have enough doses, said Zachary Thompson, director of the county’s Health and Human Services agency.

‘On the Back End’

“We may get a lot of vaccine on the back end, in November or December, but our goal is to do mass vaccinations as early as possible,” Thompson said yesterday. News coverage has heightened awareness of the pandemic “and everybody is ready to take the vaccine,” he said.

About 400 people a day are calling East Bay Pediatrics, a physician practice that serves about 14,000 children in Berkeley and Orinda, California, east of San Francisco, said Mary Gilbert, a registered nurse. The pediatricians’ office received about 300 doses of the vaccine in mid-October, and the supply was gone in three days, Gilbert said.

“It’s very hit or miss as to when we get the product,” she said. “We just keep telling people to be patient. Most people are just scared from what they’re reading in the newspapers.”

Maricopa County, Arizona, which includes Phoenix, has received about a third of the vaccine supply it had anticipated by now, said Rebecca Sunenshine, an epidemiologist with the Department of Public Health. In total, the county expects to get about 250,000 doses, she said in a phone interview yesterday.

‘Tremendous Lines’

With temperatures in the high 80s, “we had tremendous lines” that lasted for hours over the weekend at pediatrician offices, pharmacies and clinics, Sunenshine said.

The county vaccinated 17,000 people on Oct. 24, focusing on higher risk groups, she said. A series of mass immunization programs at schools has been postponed, she said.

New York City will get 800,000 doses of the vaccine by the end of this month, compared with the 1.2 million it expected, said Jessica Scaperotti, a spokeswoman for the Department of Health and Mental Hygiene. The vaccine program in schools starts today with 125 elementary schools.

President Barack Obama declared swine flu a national emergency on Oct. 24. The disease is widespread across the country and accounted for 411 confirmed deaths and more than 8,200 hospitalizations from Aug. 30 to Oct. 20, the CDC said.

Younger Population

While H1N1 produces similar symptoms as seasonal flu, it is targeting a younger population and can lead to severe illness and death. The seasonal flu kills about 36,000 people a year in the U.S., though the majority of those deaths are in people over the age of 80.

Ninety-five children 17 years old or younger have died from confirmed swine flu since April 2009, more than the toll for a typical year of influenza, according to the CDC Web site.

Concerns about shortages as a result of such reports is bound to boost demand from those afraid the product won’t be available in time to head off the disease, the CDC’s Frieden told reporters in his call yesterday.

About 11.3 million doses had been shipped to states as of Oct. 21, according to the CDC.

California received the most vaccine as of Oct. 21, at 1.3 million doses, according to the CDC’s Web site. Texas was next with 831,400, followed by New York, at 729,100. As of then, 14.1 million doses were available for ordering.

“In the next week or so, there will be a significant increase in the perceived and real availability of the vaccine,” Frieden said yesterday. “We’re working closely with the states to ensure the vaccine, once it is ordered, is delivered.”

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reuters_logoCompanies struggling to get H1N1 vaccine to US
reuters
Tue Oct 27, 2009

* Senators ask why HHS made promises

* Novartis, CSL working to improve production

* Vaccine shortage could drive demand

(New throughout)

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.

UNRELIABLE ESTIMATES

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.

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latimes-logoL.A. County free H1N1 vaccine clinics overwhelmed
latimes

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.

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park-nicollette-n73225383187_5258Who has the H1N1 vaccine?
Park Nicollet Health Services

Park Nicollet Health Services has announced it can no longer accept any requests for the H1N1 vaccine. The huge demand for the vaccine has exceeded its current supply.

That same scenario is playing out across the country. And it’s leaving many of those at high risk, frustrated and, in some cases, frightened.

With just 300,000 doses of H1N1 vaccine on its way, or in, Minnesota, and with 2.4 million Minnesotans considered high risk, many are being told to wait for vaccine, including Jen Onsum of Brooklyn Park.

Onsum says, “If I were to come down with H1N1, I know I would be in the hospital, probably in the ICU, with ventilators.”

She was hoping to be among those at Park Nicollet yesterday getting H1N1 injectable vaccine. She says, “I was scheduled for an appointment and two hours later they called back saying they realized I was too old.”

While her Spinal Muscular Atrophy puts her in a high risk group, her age, 28, takes her out of the CDC’s subset of priority groups when there is a vaccine shortage. Right now, the recommendation is that those with chronic medical conditions must be between 5 and 18 to get vaccine.

Onsum says, “I don’t think a lot of people understand how severe H1N1 is for people with diseases.”

With Park Nicollet no longer taking requests for the vaccine, those who do qualify are wondering where else they can go.

The Minnesota Department of Health decides which health providers get the vaccine first, based on a lottery.

Kris Ehresmann, Director of the Infectious Disease Epidemiology, Prevention and Control Division of the MDH, says “We had providers let us know what their needs are. Then we randomized them using random numbers. And so we started allocating vaccine, then, based on those random numbers in order to be ethical.”
The health department also set up the lottery so vaccine would be distributed more evenly geographically. That means vaccine is randomly showing up at providers across the state. The state does not have a vaccine warehouse. It’s being shipped directly to providers as it becomes available.

Dr. John Hick, Medical Director for Emergency Preparedness at Hennepin County Medical Center, says, “Unfortunately, it’s about as fair a method as you can use. But certainly providers are eagerly awaiting the injectable vaccine for those who cannot receive the flu mist.”

Hick says HCMC is still waiting for its injectable H1N1 vaccine.

That’s the kind Onsum needs. But she’ll have to wait until the major shortage is over.

She says, “It’s so important to get this vaccine to the thousands of people who really and truly need it.”

Ehresmann says many providers who have gotten vaccine are contacting their patients who currently qualify.

Of course, you can call your clinic to ask if they have it, but be prepared to wait because many clinics are overwhelmed with H1N1 calls.

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