FLU SERIES Scrambling for vaccine: Vaccine-rich states channel doses elsewhere

Dec 16, 2004 (CIDRAP News) – When doctors in Maryland needed influenza vaccine for high-risk patients recently, they didn't send a request to a private distributor. They turned to Minnesota instead.

The state health departments in Minnesota and Nebraska are serving as brokers between local public and private providers with extra flu vaccine and those in other states who want to buy it. At least 56,000 doses of vaccine have been redistributed from those two states to groups in nine others.

Minnesota has sent 50,000 doses to providers in nine states, said Kris Ehresmann, RN, MPH, manager of the immunization, tuberculosis, and international health section for the Minnesota Department of Health (MDH). The recipients are in California, Florida, Maryland, Michigan, Missouri, New York City (which is obtaining vaccine independent of the state, sources said), Ohio, Pennsylvania, and West Virginia.

In addition, Nebraska has directly transferred or assisted in moving 6,000 doses to Missouri, said Leah Bucco-White, public information officer for her state's Health and Human Services System.

Giving up future allocations
Minnesota previously had reached all high-risk residents who sought vaccine and had expanded eligibility to include healthy people 50 years and older and healthcare workers, Ehresmann said. The state also told the Centers for Disease Control and Prevention (CDC) it wouldn't need its allotment of 81,000 doses in January.

Utah and Maine also opted not to take the remaining doses earmarked for their states, said Paula Steib, a spokeswoman for the Association of State and Territorial Health Officials.

When it became clear in Minnesota that most people who qualified and wanted shots had obtained them, MDH officials began talking with people outside the state, Ehresmann said. MDH employees were able to connect Maryland officials and others to Minnesota organizations, including clinics, with extra flu vaccine. Private providers in Maryland were able to buy directly from Minnesota groups with vaccine.

Greg Reed, MPA, program manager for Maryland's Center for Immunization, said yesterday that Minnesota is shipping vaccine within a couple of days after it is requested, which is much faster than it is possible to get vaccine from regional distributors designated by the CDC. He explained that the CDC selected about 18 wholesale medical supply distributors around the country to channel flu vaccine during the shortage.

For example, an order that Maryland had placed with a distributor on Dec 2 still hadn't been processed 13 days later, Reed said. The distribution centers have to check whether the provider has an account and then create an account if there is none, which can take a while, he explained.

"We've been using Minnesota to cut through the red tape," Reed said. "I'm at this point considering Minnesota to be one of my distributors."

To prevent wasting small amounts of vaccine that might not be practical to reallocate, CDC notified physicians last week that they could use greater discretion in deciding whom to vaccinate, said Bonnie Hebert, a CDC spokeswoman. That could include returning to the general recommendations for vaccinations, such as injecting those 50 years and older, instead of restricting shots to the most vulnerable groups, as recommended after the vaccine shortage emerged.

Eligibility expanded as demand drops
While states such as New York and Maryland continue to see demand, some others, such as California, Minnesota, and Nebraska, have seen a decline. In Minnesota, officials announced yesterday that 78 of 87 counties had fully met vaccine needs, including for healthcare workers. As noted above, Minnesota expanded its vaccine eligibility guidelines beyond the high-priority groups.

California expanded eligibility on Dec 14 to include those 50 and older, emergency service workers, and people in regular contact with others at high risk for serious complications from the flu, according to a state government news release.

California is also telling counties that placed orders for the January allocation of 305,500 doses that they can get their vaccine early, said Nisha Gandhi, MPH, an adult immunization coordinator for the California Department of Health Services.

"There's no need to wait, because we have so much of November-December [vaccine] left," Gandhi said. "All in all, demand has dropped off."

Nor is there much flu activity in California right now, Gandhi added. The same holds true nationwide.

It's possible that California, which previously anticipated vaccinating up to 11 million residents, will have extra vaccine without having reached all 11 million.

"It's a very difficult situation to be in," Gandhi said. "All season long we've been dealing with high-risk people who have tried but who aren't getting vaccine. Now we may be dealing with some wasted vaccine. That's the sad part."

See also:

California's flu vaccination eligibility guidelines (Dec 14 news release)
http://www.dhs.ca.gov/ps/dcdc/izgroup/pdf/pressrelease1214.pdf

CDC map of US flu activity
http://www.cdc.gov/flu/weekly/usmap.htm

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