CDC Convenes Panel To Discuss Ethical Questions on Vaccines
For the "first time in its history," CDC has established a permanent panel of vaccine distribution ethicists "to help the agency navigate the life-and-death questions," such as who should have the highest priority to receive the flu vaccine in the current shortage and how any future epidemics should be addressed, the New York Times reports. The panel began meeting Monday (Harris, New York Times, 10/28).
California-based Chiron on Oct. 6 announced that the British Medicines and Healthcare Products Regulatory Agency suspended the company's manufacturing license at its sole flu vaccine manufacturing plant in Liverpool, England, and as a result the company will not ship any doses this season. U.S. officials expected to have about 100 million flu vaccine doses for the upcoming flu season. Because of Chiron's problems, the United States will have about 56 million standard flu vaccine doses manufactured by France-based Aventis Pasteur, the other U.S. supplier. Maryland-based MedImmune will produce about three million doses of its nasal-spray flu vaccine FluMist for this influenza season, while federal health officials are looking into acquiring additional doses of injectable vaccine from Canada and Europe (California Healthline, 10/27).
Following Chiron's announcement, CDC issued new, temporary guidelines for flu vaccinations that say those at highest risk should be inoculated first. Under the new recommendations, high-priority groups include all people ages 65 years and older; people between the ages of two and 65 who have chronic illnesses; pregnant women; nursing home residents; children taking aspirin; health care workers; those who have close physical contact with infants younger than six months; and infants ages six months to 23 months (California Healthline, 10/13).
CDC has not added further restrictions to its list, but agency director Julie Gerberding said more changes are possible. John Arras, a member of the new four-person panel and professor of bioethics at the University of Virginia, said the group could decide whether infants or seniors should have priority in receiving the flu vaccine or whether, if a pandemic were to occur, members of "crucial professions -- perhaps even undertakers" -- should receive priority. CDC officials also will have to decide whether to distribute additional doses of vaccine to nursing homes, pediatricians' offices, veterans' hospitals or convalescent hospitals.
The group does not plan to discuss "abstract issues," according to panel member Kathleen Kinlaw of Emory University. She said, "We're all very interested in being practical." The other members are Robert Levine of Yale University and Thomas Beauchamp of Georgetown University. The agency hopes to add a fifth panelist.
CDC officials and state public health authorities also participated in the meeting on Monday, which was held by conference call. According to the Times, participants spent most of the meeting discussing the science of the flu virus, the vaccine shortage and the "range of issues that confront them." Gerberding said, "Ethicists have unique tools to help shape our decisions. We want to make sure that whatever we decide is equitable.'' She added, "These are tough decisions, and they are not going to get any easier" (New York Times, 10/28).
USA Today on Thursday examined some repercussions of the flu vaccine shortage. Pharmacies across the country have cancelled flu shot clinics, doctors have turned away patients seeking the vaccine and "health officials are reduced to telling panicked callers that they should practice good personal hygiene," such as washing hands and leaving the room when another person is coughing, according to USA Today. "In a political season that has focused intently on the nation's health care system," the flu vaccine shortage "serves as Exhibit A," according to USA Today.
Moreover, "no one knows what kind of flu season is brewing, the perfect storm of a nasty strain hitting a largely unvaccinated population or a mercifully mild few months," according to USA Today. In response, experts have been discussing the profitability of manufacturing vaccine, government involvement in the process and the traditional method by which the flu vaccine is made (della Cava, USA Today, 10/28).
APM's "Marketplace" reported on the potential for a black market in flu vaccine during the current shortage. The segment includes comments from Tom Dressler, spokesperson for California's attorney general, and primary care physicians who are unable to supply vaccine to patients (Palmer, "Marketplace," APM, 10/27). The complete segment is available online in RealPlayer.
In addition, NPR's "Morning Edition" reported on the shortage and the role of market forces in public health. The segment includes comments from Dr. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases; Senate Majority Leader Bill Frist (R-Tenn.); Larry Gostin, director of the Center for Law and Public Health at Georgetown and Johns Hopkins Universities; and Janet Heinrich, director of health care and public health issues at the Government Accountability Office (Rovner, "Morning Edition," NPR, 10/28). The complete segment is available online in RealPlayer.