August 13, 2009
The Outlook on Flu Vaccinations
Everyone knows that a new vaccine for H1N1, or swine flu, is in the process of being mass-produced for this upcoming flu season. However, can enough be made to vaccinate everyone in the target age brackets in time? There are global concerns about this issue. First, a global perspective described by Tadataka Yamada, M.D., as published in the August 12th edition of New England Journal of Medicine:
Only a few countries in the world have plants for manufacturing influenza vaccine, and three companies — GlaxoSmithKline, Sanofi-Aventis, and Novartis — account for most of the world's manufacturing capacity. The number of doses of vaccine against H1N1 influenza that could be produced with the existing capacity is very large, but the sobering truth is that even if production were switched over completely from seasonal influenza vaccine to pandemic influenza vaccine, there would not be nearly enough for everyone in the world. The size of the gap in potential supply depends greatly on the dose that is required, and it may be possible to reduce the necessary dose by as much as 75% with the use of an adjuvant. The challenging problem is that much, if not most, of the manufacturing capacity is already spoken for through purchasing contracts held by many of the world's wealthy countries.
The second issue is cost. Despite the enormous technological investment required to create a vaccine, the traditional cost of seasonal influenza vaccines even in wealthy countries is quite low. For the pandemic H1N1 influenza vaccine, the major manufacturers have indicated a willingness to offer tiered pricing, with affordable prices for poor countries. Going even further, Sanofi-Aventis has committed to donating 100 million doses of its vaccine to a stockpile for poor countries, and GlaxoSmithKline has committed to donating 50 million doses. Nevertheless, financial commitments from wealthy countries will be needed to help poorer countries purchase vaccines — cost should not be a barrier to access.
This is not a time to adhere to the "first come, first served" model of business, since we may be facing a health crisis of global proportions in which all people and countries are equally at risk. To ensure fairness, full adherence to a tiered pricing scheme in which the cost to the purchaser is proportionate to its ability to pay is essential.
So, what about the seasonal flu? That supply is also limited - at least in Ohio, if you do not have insurance to cover the cost of the shot. The H1N1 shot targets young adults and children, while the seasonal shot typically targets the immune-suppressed, chronically ill, older adult population, and children under the age of 5. Ohio Health Policy Review reports,
Because of state budget cuts, the Ohio Department of Health has announced plans to buy 45,000 flu shots for Ohioans without insurance or the ability to pay for the vaccination, down from the 190,000 vaccines that the state purchased last year (Source: “State cutback to reduce supply of free flu shots,” Lancaster Eagle Gazette, Aug. 11, 2009).
That's 145,000 less than initially intended.