アメリカの訪問看護婦協会によれば、Novartis は生産がわずか10%減少しても注文を70%削減するという。コネチカット州のリチャードブルーメンタール司法長官が介入したことで、Novartis は出荷を増加させたという。(NYT)
Seasonal Flu Vaccines in Short Supply
Physicians Nationwide Fear There Are Not Enough Regular Flu Shots to Go Around
By COURTNEY HUTCHISON and GRACE HUANG
Oct. 9, 2009
For the past month and a half, Dr. Clifford Bassett has spent countless hours on the phone, trying to find enough seasonal flu vaccine for his patients.
A patient is inoculated with the influenza vaccine. Some doctors fear that efforts to distribute the H1N1 vaccine have diminished available supplies of seasonal flu vaccine.
He has been unsuccessful.
"Every time I call [the supplier], I can't get an answer," said Bassett, director of Allergy & Asthma Care of New York. "They say, 'Wait until September.' September comes around, and they say, 'Wait until October.'
"It's alarming to me that I have to spend three hours on the phone trying to round up some vaccine. Thousands of lives are at stake here."
Dr. Ulder Tillman, health officer for Montgomery County, Md., reported similar problems.
"The full-demand needs of mass flu clinics across the country were not fully anticipated," he said. "Several school-based vaccination clinics had to be canceled for lack of vaccine; community health centers ... have not been able to vaccinate their patients, [and] some private providers [say] they, too, are out of vaccine."
Bassett and Tillman are just two of a number of medical professionals across the country who suspect that the energy invested in getting out the H1N1 vaccine is pushing production and delivery of the seasonal flu vaccines to the wayside.
Bassett said he has called several colleagues in New York City to see if anyone else was having this problem and found that, while some pharmacies have the flu shot in stock, "doctors can't get supply at their offices. … I don't think there's ever been an issue before where we couldn't get enough seasonal flu vaccine."
Meanwhile, medical professionals in Iowa, Wisconsin, Minnesota, Missouri, Vermont, Montana, North Dakota, New Jersey and New York said they are getting only a fraction of the seasonal flu vaccine they ordered, according to ABC News and The Associated Press.
In all of these states, the story seems to be the same: Manufacturers are cancelling or delaying shipments, and many states will run out of flu shots until new shipments come in mid to late November. Consequently, many are having to cancel seasonal flu clinics and ration seasonal vaccine by need.
Bassett said he has heard of at least one doctor taking unusual measures to obtain doses of the vaccine.
"A colleague of mine needed flu vaccine and literally had to pay almost three times the usual cost to obtain some from an unscrupulous vendor," he said.
Swine Flu Vaccine Concerns Edge Out Seasonal Supply
Although most providers expect to receive enough seasonal flu vaccine by November, the current shortage is causing some concern.
Seasonal flu, generally speaking, is a much more serious illness than most people appreciate. Even a typical flu season results in 36,000 U.S> deaths each year, according to statistics from the U.S. Centers for Disease Control and Prevention.
In Iowa, the Polk County Health Department has had to cancel all 31 of its community flu and pneumonia clinics for the month of October because of the lack of vaccine. With 1,000 flu shots remaining, Health Department Director Terri Henkels said, the shipment for more vaccine has been delayed until early- or mid-November.
In Minneapolis, walk-in flu clinics for seasonal flu vaccine have been cancelled until Oct. 21, and, in St. Louis, Barnes-Jewish Hospital has cancelled three dates for free seasonal flu shots because of a shortage of flu shots and "higher-than-expected" demand.
Although he admitted that there are seasonal flu vaccine shortages throughout the city of Madison, Steven Van Dinter, spokesman for SSM Health Care of Wisconsin, is less concerned. "Typically we don't do seasonal flu vaccination clinics in September, so there's some time to play with. … There will be plenty for people eventually. It's just right now there's a shortage."
In Montana, health officials are putting forth a similar message, saying that while shipping delays have created a shortage of seasonal flu vaccine in the state, citizens and providers should not be concerned as back orders of flu shots will arrive well before flu season kicks into high gear in December.
Flu Shots May Be Too Late for Some
But while most states are reporting that H1N1 is the predominant flu circulating, Bassett warned that "by the time we get the supply [of seasonal flu shots], it might be too little too late. It takes two weeks for the vaccine to work, and they are asking people to wait two week between the seasonal flu shot and getting the swine flu vaccine.
"I have a lot of patients at high risk, pregnant women, people with asthma or heart disease … that need to be protected now."
Regular Flu Vaccine Supplies Run Short in Places
By ANDREW POLLACK
Published: October 9, 2009
With all the attention on the swine flu pandemic, another influenza problem has arisen, almost overlooked. Supplies of the vaccine for the garden-variety seasonal flu have run short.
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As Flu Vaccine Arrives for the Season, Some Questions and Answers (October 10, 2009)
Big City: The Mad Rush for a Flu Vaccine (October 10, 2009)
Times Topics: Swine Flu (AH1N1 Virus)
Public health departments across the country have had to cancel vaccination clinics. Doctors have had to turn away patients. And consumers have had to make extra efforts to get immunized.
“We had patients scheduled; we had to cancel the patients,” said Dr. Ralph K. Messo Jr., who practices in Staten Island and Colts Neck, N.J.
Dr. Messo said he received only 150 of the 1,000 shots he ordered. “They keep giving us a shipment date, and then they don’t deliver,” he said.
Karyn O’Malley of New Canaan, Conn., said the town’s flu clinic, where her family had gone for the last two years, was canceled this year. The family’s pediatrician vaccinated Ms. O’Malley’s two daughters but then ran out of vaccine and placed her son on a waiting list. She received her own shot at Walgreens, but the drugstore did not have vaccine for children. And when her husband went to Walgreens a week later, it had run out of adult vaccine as well.
“It’s frustrating,” Ms. O’Malley said.
Public health officials and vaccine manufacturers say the shortfall was caused in part by the need to shift resources to the pandemic flu vaccine. There also appears to be an increase in demand probably because swine flu has raised public concern about flu in general.
They also say it is temporary. Ample vaccine should be available by November, leaving enough time to be inoculated before the seasonal flu arrives in force later in the winter. Virtually all the influenza virus circulating right now is the pandemic H1N1 strain, also known as swine flu.
“We just ask for people’s patience,” Dr. Anne Schuchat of the federal Centers for Disease Control and Prevention said Friday at a news conference.
Federal authorities are recommending that many people get vaccinated both against the seasonal flu and the new pandemic swine flu, though the priority groups for each vaccine differ somewhat. They say the seasonal vaccine will not protect against the pandemic strain.
Still, some doctors say the vaccine that arrives in November might go unused because consumers will have moved on. And because seasonal flu causes thousands of deaths each year, they say, the issue needs more attention.
“I was just horrified that no one was discussing it,” said Dr. Symra A. Cohn, a Manhattan internist.
Questions are also arising about how vaccine is allocated by the manufacturers and distributors. Some doctors and public health officials complain that big drugstore and grocery chains seem to have plenty of vaccine ― and even advertise that ― while they are left wanting.
“There certainly seems to be enough vaccine around if you’re willing to pay for it,” said Dr. Dora Anne Mills, the public health director for Maine, referring to the $25 or so that drugstores charge. “And yet I can’t get vaccine to public health clinics to serve the homeless and school kids, etc.”
To be sure, the shortage is nothing like the severe one in 2004, when some people waited in line for hours for a shot. Most years, millions of doses go unused.
Another reason for the temporary shortfall is that demand appears to be up sharply this year. Yet manufacturers cannot make extra vaccine to meet that demand because they have shifted to making pandemic vaccine.
Through Sept. 26, physicians had administered four times as many doses of seasonal vaccine as they had by the same point last year, according to SDI Health, which tracks insurance claims by physicians.
That probably reflects the fact that people are getting their seasonal vaccinations earlier this year, as well as true growth in demand. Health authorities have urged people to get seasonal flu inoculations earlier than usual in order to leave time for the pandemic flu vaccinations, which are now beginning.
Over all, the five flu vaccine manufacturers said in June that they hoped to deliver a combined 119 million doses this year, which is more than enough for a typical flu season.
But two makers will produce somewhat less than they hoped, so the total will end up at about 114 million doses, of which 77 million doses have been delivered.
Sanofi Pasteur, the largest supplier, has delivered only 30 million of its projected 50.5 million doses so far, in part because of production difficulties, a spokeswoman said. She said the rest should be delivered by the end of November.
Manufacturers say they try to be fair in allocating vaccines. But some customers end up with sharper cutbacks than others.
The Visiting Nurse Associations of America said Novartis cut its order by about 70 percent, even though the manufacturer’s overall production was down only 10 percent.
After Richard Blumenthal, the attorney general of Connecticut, intervened, Novartis increased its shipments to the association.
Andrin Oswald, the head of the vaccine business for Novartis, said the company took into account the uses of the vaccine and whether the customer had other suppliers.
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