Some States Easing Flu Vaccine Restrictions

After several weeks of scrambling to find and ration flu vaccine amid a nationwide shortage, many states are reporting unexpected surpluses of vaccine and several are easing restrictions on who can get vaccine from private providers.

The excess of vaccine is partly due to many "high-risk" people not getting flu shots, along with a mild flu season and patchy availability of vaccine across the country. To make sure doses available in doctors' offices and private clinics aren't wasted, states such as California, Colorado, Iowa, Minnesota and Wisconsin are expanding eligibility beyond the suggested high-risk groups outlined by the U.S. Centers for Disease Control and Prevention.

However, states such as Maryland, Rhode Island, Vermont and Virginia are still experiencing a demand for flu vaccine.

CDC defines high-risk individuals as adults over 65, children from six months to 23 months old, pregnant women, people with chronic diseases and adults who live with infants.

The CDC Advisory Council on Immunization Practices recommended Dec. 17 that states with excess vaccine be allowed to ease eligibility limits for people getting vaccine from both private and public providers after Jan. 3, 2005, said Llelwyn Grant, a spokesman for CDC. This recommendation followed reports that 82 percent of state health departments had sufficient vaccine, and that about half of the people in high-risk groups have not been vaccinated.

"They're stepping aside and that is not what we want them to be doing," CDC Director Julie Gerberding said Dec. 16.

One health expert said one reason some high-risk patients haven't gotten a flu shot is that they're being "Minnesota Nice" and thinking of others before themselves.

"Some people are not perceiving themselves as high-risk of getting sick, so they're not taking the vaccine from someone who might need it more," said Claire Hannan, executive director of the Association of Immunization Managers. "The bottom line is that some vaccine is not being used because (providers) are not getting their high-risk to come in and get it."

Vaccine possessed by state and local health departments is still recommended for use among the high priority groups, Hannan said. Some states, including Minnesota and Nebraska, have diverted flu vaccine shipments to their public health departments to places where the need is greater.

In Minnesota, 78 out of 87 counties have fully met their need for vaccine for high-risk groups and health care workers so the state has returned 81,000 doses. These will be redistributed to clinics, hospitals and health centers in California, Michigan, Ohio, Missouri, West Virginia, Florida, Pennsylvania and New York City, according to Doug Schultz, spokesman for the Minnesota Department of Health.

"We told CDC that since there were other states that hadn't met their long-term care needs, it didn't make sense to take all of those doses when there was a need elsewhere," Schultz said.

Other states have loosened their criteria and are letting more people roll up their sleeves for a flu shot:

  • The California Department of Health Services expanded flu shot eligibility Dec. 14 to include all adults over 50 years old, emergency service workers and people who have regular contact with people in high-risk groups. 
  • In Wisconsin, Gov. Jim Doyle (D) did the same Dec. 13. "Because people were willing to follow our first public health order, we avoided the nightmare scenario - running out of vaccines and leaving our most vulnerable citizens unprotected," Doyle said in a statement. "Now, we are ready to take the next step, and make the vaccines available to more of those who need them." 
  • Massachusetts lowered the age to get a flu shot from 75-years-old to 65-years old on Dec. 1. 
  • Arkansas public health officials were discussing the possibility of expanding eligibility criteria or sharing surplus doses with other states, said Ann Wright, a spokeswoman for the state health department.
  • And Arizona is on track to vaccinate their high-risk population, but it's too early to tell if they'll expand eligibility, said Will Humble, the state's bureau chief for disease control. "I just don't want to leave anybody high and dry because there are 50-year-olds in line," Humble said.

 At least 15 states issued emergency public health orders limiting flu vaccine eligibility, some carrying stiff penalties. While many orders have been lifted, state public health officials say they were useful in dealing with the shortage.

"Having those kinds of state orders not only helped provide doctors clarity on who should get what, but also helped protect and insulate those doctors from pressures from those who shouldn't get the vaccine," said Shelley Hearne, executive director of the Trust for America's Health, a non-profit that aims to make disease prevention a national priority.

The Trust released a report Dec. 14 that examined states' bioterrorism preparedness, including readiness for a pandemic flu outbreak. The report found that 20 states and the District of Columbia did not have a publicly available plan for dealing with a large-scale flu outbreak. The report includes estimates of potential deaths and hospitalizations state-by-state in the event that 35 percent of the population was infected with pandemic flu.

About 36,000 Americans die of influenza each year, according to the Association of State and Territorial Health Officials, which has been tracking state responses to the flu vaccine shortage on its Web site.