While U.S. health officials promise there will eventually be enough vaccine supply to meet demand, at the moment shipments are running late and being released in dribs and drabs.
"The entities that ordered vaccines are receiving only small-to-medium amounts of what they ordered," said Donna Brown, government affairs counsel for the National Association of County and City Health Officials, in Washington, D.C.
"Given that we're expecting a full amount, I think it's fair to say that it is less than they hoped they would get but not necessarily less than they've gotten in the past few seasons," she added.
The end result is that high-risk individuals who should be receiving the vaccines first may not be finding any. The U.S. Centers for Disease Control and Prevention has asked that the elderly, babies, pregnant women, people with chronic illnesses, and health-care workers be given priority until Oct. 24. But many of these people aren't getting vaccinated and may have to wait in line with the general public later in the season.
"Many, particularly elderly people who are accustomed to getting flu shots from private physicians or those in nursing homes and institutional settings, are not able to get their flu shots," Brown said. "Health departments, which customarily plan on having clinics in mid to late October are having to postpone or cancel until such time as they get an adequate supply of vaccine."
Patrick Libbey, executive director of the National Association of County and City Health Officials, said a survey of 120 local health departments in all 50 states revealed that all but six were reporting delays or only partial shipments of vaccine, the Associated Press reported.
That same survey found that local health departments were "struggling to abide by CDC recommendations" and to reach home-bound seniors and health-care workers. Local health departments in California reported receiving partial shipments from Sanofi Pasteur and no shipments at all from Chiron Corp., two of the four manufacturers providing vaccine this year. Chiron just announced it would not be able to provide all of the promised 18 million doses of vaccine for this season, due to continuing problems at its British production plant.
On the other hand, the survey found that those who offer flu-shot clinics in large chain stores such as Walgreen's, seem to have all their doses.
"Distribution is not uniform within the manufacturers," said Dr. Mark Siegel, a clinical associate professor of medicine at New York University School of Medicine. "In general, Sanofi has the big contracts and Chiron ends up mainly in doctor's offices. Distribution varies by manufacturer, which guarantees we're not going to have uniform distribution."
And because Chiron supplies many doctors' offices, it's those "offices that are in the lurch," said Siegel, who is author of False Alarm: The Truth About the Epidemic of Fear.
U.S. health officials are trying to avoid last year's debacle when contamination problems at the Chiron plant outside Liverpool, England, slashed by half the anticipated 100 million vaccine doses intended for the American public.
The U.S. Food and Drug Administration issued a statement Monday anticipating "the production of more vaccine than last year... despite Chiron's lowered projections."
"While occasional spot shortages may occur as manufacturers complete their final testing, we expect these shortages to resolve as vaccine continues to be released to health-care providers and others who administer the vaccine," the statement continued.
"We do not expect any shortages," added Lola Russell, a spokeswoman for the U.S. Centers for Disease Control and Prevention. "As far as we know, there is equitable distribution across the country. We have not heard reports of anyone not having vaccine at all."
Russell's last statement was in contrast with local health officials' reports.
Even without Chiron's contribution, the U.S. market should see 71 million doses this year, most provided by Sanofi and the rest from GlaxoSmithKline and MedImmune Vaccines.
Local, state and federal officials stressed that supply should meet demand in the coming weeks and months. "There seems to be a consensus that there will be plenty to meet the expected demand," Brown said.
Flu season can begin as early as October and run as late as May. The FDA stated the best time to get vaccinated is October or November, but "getting vaccinated in December or later still can be beneficial."
Russell, of the CDC, said, "We cannot produce or distribute over 71 million doses in just a matter of weeks. It does take time. It is a process. At the end of September, 30 million doses had gone out and more than 50 million will have gone out by the end of this month."
Vaccine will continue to be produced into early January, which is the start of peak season, she added.
"We don't want to create the impression that if you don't get your flu shot today that you're going to be in trouble," Russell said. "People at high risk, along with people who are healthy, can continue to get vaccinated after Oct. 24."
While this may work in theory, it doesn't always work in practice, said Brown, of the National Association of County and City Health Officials.
"Experience is that once someone is turned away once, they are often likely to just give up," she said. "So, demand later in November and December tends to diminish, but that will be when the supplies are probably complete."
But even when vaccine supplies are sufficient, inoculation rates vary among Americans, depending on race and ethnicity, a government report released Thursday found.
For Americans 65 and older, vaccination rates in 2003 averaged 69 percent for whites, 48 percent for blacks, and 45 percent for Hispanics, according to the Oct. 21 issue of the CDC's Morbidity and Mortality Weekly Report.
And for Americans 18 to 64 years of age with one or more high-risk conditions, such as cancer, heart disease or diabetes, the rates were 36 percent for whites, 30 percent for blacks and 27 percent for Hispanics.
All those levels are substantially lower than 2010 federal targets of 90 percent for people 65 and older, and 60 percent for individuals with a high-risk condition, the report said.
Similarly, U.S. health officials recommend that all pregnant women receive a flu shot. But only 13 percent of these women were vaccinated in 2003, according to the report.
More information
The American Lung Association has a flu shot locator.
