A Guessing Game - H1N1 Vaccine Availability

By Susan Kim, STAFF WRITER

Many health officials are blaming the current shortage of flu vaccines, for both the so-called "regular" flu and H1N1 "swine" flu, on a matter of bad business judgment, notably unrealistic projections from vaccine manufacturers regarding how quickly they can make and distribute their products.
County and state health officials are often bearing the brunt of public frustration for what U.S. Health & Human Services Secretary Kathleen Sebelius termed "overly rosy" numbers that were relayed by vaccine manufacturers. Those original numbers, which were accepted at the federal level, were passed down to state and local health departments - despite vaccine manufacturers' frequent history of over-projecting their capabilities.
Maryland state officials were told by the Centers for Disease Control (CDC) at the end of September that they would receive nearly 1 million doses of the H1N1 vaccine for October. That number was reduced to 530,000, said David Paulson, spokesperson for the Maryland State Department of Health and Mental Hygiene (DHMH).
In turn, school systems and public health departments in Howard and Anne Arundel counties have been left to delay their vaccine plans, often at the last minute, after receiving far fewer vaccines from the state than originally projected.
Five manufacturers are licensed by the U.S. to produce both seasonal and H1N1 vaccines and some have elected to focus on producing H1N1 first, since in most states that virus is responsible for 90% or more of current flu cases.

Promises, Promises
For local and state officials, predicting which vaccine will be available - and when - has become a guessing game.
In Howard County schools, a FluMist clinic for regular flu was offered at 15 schools before the clinics were halted by the state on Oct. 1, said Howard County Health Officer Peter Beilenson.
"The reason was that you need four weeks between receiving a nasal mist for regular flu and receiving a nasal mist for H1N1," he said. However, a person who has received a mist version for one type of flu can receive a shot for the other type without a waiting period.
For the vast majority of those students, four weeks have passed with no opportunity to receive the H1N1 mist. But the state, relying on those projections from vaccine makers and federal officials, didn't need to order a halt anyway.
As more of both types of vaccines become available, schools will host clinics and no schools will be dropped from the list, said Beilenson.
"I do think the vaccine makers over-promised," he said.

Tweeting and the Net
Anne Arundel County has set up an appointment system to administer H1N1 vaccines as the county receives them. The state distributes vaccines to the counties based on a county's population, said Elin Jones, public information officer for the Anne Arundel County Department of Health.
When Jones and other health department officials receive word that vaccines have arrived, they update the department's web site and send out announcements through e-mail and through the social networking site, Twitter. The web site's page visits have skyrocketed from 10,000 page views per day to 25,000 page views per day, she said.
"The site started running more slowly," said Jones, "so we removed the bells and whistles, the special sound effects. We had to become more functional."
When vaccines are available, people can call the health department to set up an appointment. When appointments are filled, the web site and other announcements indicate no more vaccine is available.
Beilenson and Jones said they believed that the state is handling its role well, considering the high guesswork factor, and that they believe counties are receiving a fairly allotted number of vaccines.

'A Lot of Frustration'
At the state level, Paulson commended Howard and Anne Arundel counties for their handling of vaccine distribution.
Howard County, he said, "has done it beautifully, with a specialty clinic for pregnant women," he said.
Anne Arundel's appointment system has also been working well, he said. "It is much better for folks to be frustrated that they didn't get an appointment than to wait in line at a clinic and get nothing," he said.
"The original projections were what the federal government depended on from the manufacturers," added Paulson. "Since then, there have been production process issues that have crept up. It's creating a lot of frustration among members of the public and other organizations."
DHMH is told daily how many vaccines are available to order, said Paulson. "We haven't had a week go by in which, for a day or two, the available supply has been zero. We order 100% of what they make available to us."
Beilenson, Jones and Paulson all said they believe that there will eventually be enough vaccines, both regular flu and H1N1, for everyone. But none of them could predict when that would be.
"Nothing would solve this problem like a million more doses," said Paulson.