Clinics face flu shot shortage as demand for immunizations rises

ATLANTA —A high demand/low supply scenario had been expected for the H1N1 vaccine, especially as manufacturers only started feeding the Centers for Disease Control and Prevention distribution engine Oct. 5 with MedImmune’s FluMist nasal vaccine and a week later with injectables.

But that high demand/low supply scenario also impacted the delivery of seasonal influenza vaccines earlier this month, as evidenced by a spate of last-minute flu clinic cancellations. For example, Mollen Immunization Clinics, a nurse clinic provider scheduled to administer regular seasonal flu shots at select Rite Aid stores in California, Colorado, Idaho, Oregon, Utah and Washington, had cancelled clinics scheduled mid-October through mid-December, citing a shortage of the regular season flu vaccine.

Vaccine manufacturers had started shipping seasonal inoculations earlier than usual this year, in part to make room on the production line for the H1N1 vaccine, and in part to supply flu clinics that were opening some 30 days earlier this season than seasons past. For example, Walgreens began offering seasonal flu vaccine clinics by Sept. 8, and in the first two weeks delivered more than 1 million shots. “We’ve seen a tremendous response to the early availability of seasonal flu shots,” stated Walgreens president and CEO Greg Wasson then.

“We have seen a significant increase in the number of flu shots we’ve provided this year compared to the same time last year,” said CVS Caremark spokesman Mike DeAngelis. “And our pharmacists and nurse practitioners are speaking more often with customers about both seasonal and H1N1 flu.”

“The good news is, we have more seasonal flu vaccine out than we typically would at this time of year,” said Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. By the first week of October, more than 77 million doses of seasonal vaccine already had been distributed. “Bad news is, more people want it than can get it.”

According to the CDC, the pressure to field an H1N1 vaccine in time for it to be effective may have impacted the full delivery of seasonal influenza vaccines. “We know that some providers, some communities, some health departments don’t have as much [seasonal] vaccine that they ordered,” Schuchat said. “We ask for people’s patience. I know this is challenging, [but] there’s time to get the seasonal vaccine and more will be coming out regularly,” she said.

Schuchat explained that some vaccine manufacturers have adjusted their calendars to make sure they can distribute the H1N1 vaccine as early in the season as possible.

The last time high demand/low supply closed flu clinics was in 2005, when consumers were worried about avian flu, and manufacturing issues involving vaccine manufacturer Chiron prompted delays in distribution. In addition, Sanofi-Aventis had encountered some minor distribution issues that year.

As for the H1N1 vaccine, many pharmacy operators are expecting that they may serve as distribution points beginning in November, or as soon as high-priority groups, such as healthcare providers, pregnant women and other caregivers, have received the vaccine. Already, Rite Aid is serving as a distribution point for high-priority patients at several locations in Oregon, and the chain, like others, has proactively approached health departments at all government levels. “We have registered in every state,” Cheryl Slavinsky, Rite Aid spokeswoman, told Drug Store News, across every level of government from state to local health departments.

“Regarding H1N1 vaccine, [CVS] is actively registering with states to be a service point for the vaccine, and [we] are waiting to hear back on which states we’ve been selected in,” DeAngelis said.

Convenient Care Clinics also are approaching healthcare departments. “We’ve been in partnership with [the Centers for Disease Control and Prevetnion] for a long time, as have our members, so we’re certainly thought about as a site for easy access to H1N1 [vaccinations] once the planning unfolds,” Tine Hansen-Turton, Convenient Care Association executive director, told Drug Store News. At least 30% of Americans live within 10 miles of a convenient care clinic, Hansen-Turton added.

Since the spring, retail clinics have been finding ready allies at the local county health department level, added Lori Knowles, RediClinic COO. “We’ve found that those contacts [have been] extremely helpful,” she said.

Nurse practitioners and physician assistants operating in retail clinics have been on the front line of the H1N1 virus ever since it was first identified in the spring as the “swine flu.” “We play a critical public health function in the sense that people came to clinics with lots of questions,” Hansen-Turton said. “We certainly saw an increase in usage of the clinics in treating flu-like symptoms [since news of H1N1 first broke],” she added, noting that patients presenting with influenza-like illnesses had continued throughout the summer.

So far this season, influenza already has proven to be more prominent this early in the year as compared with years past. Visits to doctors for influenza-like illness continued to increase in the United States for the week ended Oct. 3, according to the CDC, and were higher than levels expected for this time of the year.

For patients between the ages of 5 and 49 years, hospitalization rates from April through October already have exceeded average flu season rates for that period.

A total of 37 states were reporting widespread influenza activity at the top of October, and almost all of the influenza viruses identified were of the 2009 H1N1 influenza A viruses. For the week ended Oct. 3, only Washington, D.C., Hawaii and Vermont reported less than regional influenza activity.