Swine flu: Wherefore art thou vaccine?

Nov 9, 2009 10:33 AM

With the swine (H1N1) vaccine production and distribution slower than expected, many Americans are having trouble finding vaccine, according to a new poll. And the trickle of vaccine has caused problems for mandatory vaccination programs for health care workers, as well as some public health officials when it was reported that Wall Street firms were delivered vaccines while hospitals continue to struggle with a shortage of supply.

Public having difficulty finding vaccine

A poll from the Harvard School of Public Health conducted October 30th through November 1st found that 21 percent of high-priority adults, and 41 percent of all parents tried to get the H1N1 vaccine, but 66 percent of both populations were unsuccessful. In response to the Harvard poll, the Centers for Disease Control and Prevention’s Anne Schuchat, M.D., said, "I’m very mindful of the frustration people have had, whether from information gaps or just the basic availability of the vaccine. I think it should be getting better over the weeks ahead." According to the CDC, the number of vaccine doses available has doubled over the past two weeks, and the supply is expected to continue to grow.

Backlash against Wall Street

The lack of H1N1 vaccine availability also caused a black eye for health officials in New York City, and several Wall Street firms including Citigroup, Morgan Stanley and Goldman Sacks, when it was reported that they were being shipped substantial doses of the vaccine, perhaps ahead of some hospitals. A Wall Street Journal blog summed up reaction to the news:

"It is official: Goldman Sachs is more important than you are…At least that is the way that the public may perceive a WSJ story today that Goldman was one of several Wall Street firms that received large dosages of swine flu vaccines, while some New York City hospitals and clinics are running out of the vaccine."

Last week, CDC chief Thomas Frieden sent a letter* to state and local health authorities reminding them to prioritize vaccine distribution to those who need it most. "While vaccine supplies are still limited, any vaccine distribution decisions that appear to direct vaccine to people outside the identified priority groups have the potential to undermine the credibility of the program," he wrote. The CDC said that occupational vaccine clinics are an important part of the distribution system. "There’s nothing wrong with an employer based clinic," said Schuchat. But health officials stressed that such workplace distribution should focus on priority groups. Meanwhile, a spokesman for Morgan Stanley told Reuters that they donated their supply to local hospitals.

Healthcare workers resist vaccination

The vaccine shortage, along with opposition from some health care workers, has also led many hospitals and public health officials to abandon plans to mandate vaccination for health care workers. Immunization of doctors, nurses and other hospital personnel is one of the best ways to reduce infection in those who may suffer the most—those who are already sick. USA Today reported that the University of Iowa Hospitals and Clinics, with 6,300 workers, dropped its vaccination mandate after the union representing its employees won an arbitration ruling.

Meanwhile, New York State reversed its controversial mandatory vaccination policy, which was also facing a legal challenge, due to the supply shortage. The legal challenge is unresolved, but a new editorial in the New England Journal of Medicine argues powerfully that the vaccination mandate would and should prevail, because the judiciary has consistently ruled that the right of a person to refuse immunization is outweighed by the protection vaccination offers to the community. The author concludes:

"Health care workers have a profound effect on patients’ health. Although they have the same rights as all private citizens, it is likely that courts will continue to make the health and safety of patients the priority in permitting exceptions to individual rights."

We’ve discussed the shamefully low vaccination rate of health care workers before. One way or another, hospitals and other health care facilities need to protect consumers from infection and its dangerous complications by improving dismal immunization rates. "Health care workers have an obligation to their patients and their communities," says John Santa, M.D., director of the Consumer Reports Health Ratings Center. "Immunity may not seem like much of a benefit to you directly, but if you work in a health care setting, it could save children and families a lot of hardship, serious illnesses, and lives."

If you're looking for the H1N1 flu vaccine, try the flu shot locater at flu.gov.

—Kevin McCarthy, associate editor

*links to PDF