Health Officials, Manufacturers To Hold Global Summit on Flu Vaccine Shortage, Other Infection Concerns
The World Health Organization has called for an "unprecedented summit" to discuss the recent U.S. flu vaccine shortage and the possibility of a global flu pandemic triggered by the emergence of avian flu in Asia, the AP/Las Vegas Sun reports. Public health officials from several countries and officials of 16 vaccine manufacturers plan to meet Nov. 11 in Geneva, Switzerland (Marchione, AP/Las Vegas Sun, 11/1).
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 to the United States this season. U.S. officials had expected to have about 100 million flu vaccine doses for the upcoming flu season. France-based Aventis Pasteur, the other U.S. standard flu vaccine supplier, this influenza season will provide 56 million vaccine doses, and Maryland-based MedImmune will produce about three million doses of its nasal-spray flu vaccine FluMist (California Healthline, 10/29).
WHO influenza chief Klaus Stohr said WHO hopes to get "all issues on the table" at the summit -- including economic and scientific concerns -- that prevent companies from manufacturing more vaccine quickly (AP/Las Vegas Sun, 11/1).
Canadian Chief Public Health Officer David Butler-Jones said that ID Biomedical has met its commitment to the Canadian market and may sell its surplus vaccine to the United States (Fox, St. Petersburg Times, 10/31).
ID Biomedical's Quebec City plant has offered 1.2 million additional doses that the company manufactured in case of unexpected increased demand in Canada. Federal health officials are considering importing the additional vaccine if the manufacturing facilities pass FDA inspection (American Health Line, 10/29). If U.S. officials import the vaccine, it would be directed to those in high-risk groups, according to ID Biomedical spokesperson Michele Roy. Butler-Jones said that vaccinating high-risk U.S. residents is a higher priority than vaccinating healthy Canadians. He said, "That's not very neighborly -- I would give it to the American who's at high risk" (St. Petersburg Times, 10/31).
A CDC-appointed permanent panel of medical ethicists is discussing "whether some high-risk groups are more deserving than others" to receive the flu vaccine and which high-risk individuals should receive priority, Long Island Newsday reports (Ricks, Long Island Newsday, 11/1). The panel of vaccine distribution ethicists began meeting Monday (American Health Line, 10/28).
Jody Hershey, director of public health in Christiansburg, Va., and former president of the National Association of County and City Health Officials, said at a CDC meeting of vaccine experts last month, "We're dealing with a lot of ethical issues, whether nursing home patients should get the vaccine or should it go to people with chronic illnesses. We're also dealing with children. Are kids at a higher priority over the elderly and the chronically ill?" Nancy Dubler, director of bioethics at Montefiore Medical Center, said, "It's important to note the principal of justice precludes allocating resources on the basis of social worth and other morally arbitrary criteria. You need to have something in place that has the benefit of transparency and is much less open to abuse." The panel is expected to produce guidelines in the next few weeks (Long Island Newsday, 11/1).
Some experts attending the Interscience Conference on Antimicrobials and Chemotherapy -- the American Society for Microbiology's annual meeting in Washington, D.C. -- said that if the avian flu virus mutates enough to mix with the human flu virus, "it could easily pass between humans and trigger a global pandemic," the AP/Sun reports. A pandemic usually occurs every 20 to 30 years when a flu strain mutates dramatically and can kill millions of people worldwide (AP/Las Vegas Sun, 11/1).
WHO officials on Friday released a report that found that healthy ducks can carry the avian flu strain, also known as H5N1 virus. While chickens that carry the virus show symptoms, ducks carrying the virus appear to be healthy and can infect humans. Stohr said, "There is the potential every second, every moment, that this H5N1 virus will exchange its genetic material if there is a co-infection in a human. These clusters look as they would if a pandemic (were to) appear. So they have to be investigated." Stohr said that lab experiments suggest that certain flu drugs, including Tamiflu and Relenza, are effective treatments against avian flu. However, avian flu is resistant to other drugs, such as amantidine and rimantidine (Wall Street Journal, 11/1).
According to USA Today, several experts at the ASM meeting said that "the best defense against flu, whether a pandemic strain or the regular variety, is vaccine" (Manning, USA Today, 11/1). The global capacity for flu vaccine manufacturing is 300 million doses, and it would take at least six months to develop a new vaccine to counter a pandemic strain (AP/Las Vegas Sun, 11/1). The National Institute of Allergy and Infectious Diseases in May contracted with Aventis and Chiron to develop and test new vaccines to prevent avian flu; however, no vaccine for the avian flu strain has yet been created (Chase, Wall Street Journal, 11/1).
Stohr said, "We believe that we are closer to the next pandemic than we ever were. ... If we continue as we are now, there will be no vaccine available, let alone antivirals, when the next pandemic starts." He added, "We have a window of opportunity now to prepare ourselves." Wendy Keitel of Houston's Baylor College of Medicine called the current U.S. flu vaccine shortage a "dress rehearsal" for the rationing and emergency measures that would be necessary if a pandemic occurred. "The ability to respond with the production of billions of doses of vaccine is quite limited. We need to think through these problems now," Keitel said. She added, "Ninety percent of vaccines are produced in 10 countries that have 10% of the world's population" (AP/Las Vegas Sun, 11/1).
Kathleen Neuzil of the University of Washington's School of Medicine said that during most years, only 43% of people at high risk of contracting serious illness from the flu seek vaccinations. She said, "The current flu vaccine supply issue illustrates that the first and most important part of pandemic preparedness is to be prepared for annual flu. Flu is a serious disease, and we have not taken it seriously" (USA Today, 11/1). Members of the Alliance for the Prudent Use of Antibiotics at the conference Sunday issued a report requesting that Homeland Security program funds be used to monitor and fight epidemics complicated by the rise of resistant germs (Wall Street Journal, 11/1).
The nation's supply of thimerosal-free flu vaccine is likely to be insufficient "for the next several years,'' despite public health officials' recommendation to immunize infants against the virus, according to members of the American Academy of Pediatrics. About 4.6 million doses of thimerosal-free vaccine have been manufactured this year despite an increased demand of more than 12 million flu shots annually. The thimerosal-free vaccine shortage is not linked to the Chiron production problem. However, many health officials are not concerned about the shortage because scientific studies have "largely refuted suggestions that thimerosal is behind the country's record rates of autism and other neurological disorders," the San Jose Mercury News reports.
According to the Mercury News, health officials were aware that there would not be enough mercury-free influenza vaccine to meet the increased demand for childhood vaccination this year; however many recommend that infants still receive a flu shot because the vaccine "is still better for children than the flu," according to the Mercury News (Sevrens Lyons, San Jose Mercury News, 11/1).
The Contra Costa Times on Sunday published an interview with Bruce Gellin, director of HHS' National Vaccine Program Office. In the interview, Gellin addresses FDA's role in evaluating Chiron's manufacturing process, HHS' plans to secure the national flu vaccine supply for next year and discussions taking place within the agency to avoid a similar problem in the future (Silber, Contra Costa Times, 10/31).
U.S. Surgeon General Richard Carmona in Denver on Thursday said the national flu vaccine shortage is "not a catastrophe, not something worth seniors standing in big lines for." Carmona added, "We're usually begging people to get the flu shot at this time of year" (Scanlon, Rocky Mountain News, 10/29).
NPR's "Weekend Edition Saturday" reported on the increasing numbers of U.S. residents who are traveling to Canada to receive flu shots. The segment includes comments from Claude Bachand, who represents St. Jean in Canadian Parliament; Dan Stewart (R), mayor of Plattsburgh, N.Y.; Laurie Williams from the Clinton County Health Department; and U.S. residents who received flu shots in Canada (Mann, "Weekend Edition Saturday," NPR, 10/30.) The complete segment is available online in RealPlayer.
NPR's "Morning Edition" on Monday reported on a study in Temple, Texas, that is investigating whether providing flu vaccinations for all children -- who are the primary transmitters of flu -- could decrease deaths among elderly U.S. residents. The segment includes comments from Dr. Manju Gaglani, pediatric infectious disease specialist at Texas A&M University; Dr. Paul Glezen, professor of pediatrics at Baylor College of Medicine; Thomas Reichert, who led a study of a Japanese flu-control policy based on vaccinating children; and Dr. Benjamin Schwarz with the National Vaccine Program Office (Knox, "Morning Edition," NPR, 11/1). The complete segment is available online in RealPlayer.