The nationwide shortage of flu vaccine tossed a health management crisis onto the shoulders of state health officials, governors and attorneys general, who are trying to inventory, ration, coax or even threaten their way into getting vaccine to those who need it most.
In Michigan, the state Department of Community Health issued a public health order Oct. 13 instructing health care providers to limit flu shots to high-risk people. Violation of the order is a misdemeanor offense punishable by up to six months in prison and a fine of $200. Emergency orders to ration vaccine also were issued in California, the District of Columbia, Massachusetts, New Mexico, Oregon, South Carolina, Vermont and Wisconsin.
Taking stock of supplies is another first step. Maine Gov. John Baldacci (D) announced that he's delaying flu vaccinations for state workers and asking businesses to put a hold on any supplies of flu vaccine they purchased. He's asking health care providers to call the state health department and report how much vaccine they have.
Other states such as Minnesota and North Dakota are surveying local clinics, long-term care facilities, hospitals and other flu shot vendors county-by-county to determine how much vaccine they have on hand relative to their need.
Vermont Gov. James Douglas (R) is looking for help from outside the country. A proponent of importing less-expensive prescription drugs from Canada, Douglas sent a letter asking for federal government approval of his plan to import 1.2 million doses of flu vaccine from a company in Quebec, the Burlington Free Press reported.
This is not the first time there's been a dearth or delay in the delivery of flu vaccine, but some state actions speak to the severity of this year's shortage, said Claire Hannan, executive director of the Association of Immunization Managers.
"This year every state is challenged with trying to figure out where vaccine is in their state," Hannan said.
The U.S. Centers for Disease Control and Prevention is recommending that vaccine be reserved for senior citizens over 65 years of age, children from 6 months to 23 months old, pregnant women, people with chronic diseases and adults who live with infants. Most state and local health officials are following the federal guidelines.
While President Bush, Democratic challenger John Kerry and several governors have said they're foregoing their annual flu shot, the shortage has created friction between those who have access to vaccine and those who don't. On Capitol Hill, the attending physician urged all 535 lawmakers to get the vaccine even if they are young and healthy, The Washington Post reported. However, that sparked criticism from some members of Congress and the president, who said only those who meet federal guidelines should be vaccinated. In response, the physician is reportedly rescinding his recommendation.
The vaccine shortage also is spurring state law enforcers into action. At least five states Connecticut, Kansas, Kentucky, North Carolina and Texas are trying to prevent flu vaccine price gouging, something U.S. Secretary of Health and Human Services Tommy Thompson is urging of all state attorneys general.
In Texas, Attorney General Greg Abbott filed a lawsuit against two flu-shot distributors that allegedly violated state law by charging hospitals in the state inflated prices for flu vaccine, according to an Oct. 21 press release.
In Kansas, an undercover investigation by the state division of consumer protection led Attorney General Phill Kline to file a lawsuit against a Florida company for promising to deliver and sell a vial of five doses of flu vaccine to a Kansas City pharmacy for $900 "with the knowledge that the vaccine was to be used in a nursing home." The suit alleges the vaccine's listed price was $85.
In North Carolina, Attorney General Roy Cooper also called on residents to turn in "unscrupulous" companies that may be profiting from the shortage. "If you suspect you're being overcharged for a flu shot, let my office know about it," he said in a statement.
And in Connecticut, Gov. M. Jodi Rell (R) asked residents to report inflated flu vaccine prices to a state e-mail address firstname.lastname@example.org or to a telephone hotline, 860-509-8000.
Other states have responded with additional measures to protect public health.
At least one health policy advocate said the flu vaccine shortage has exposed gaps in the nation's public health system.
"We have 50 different health structures in this country," said Shelley Hearne, executive director of the Trust for America's Health, a Washington, D.C.-based advocacy group that aims to make disease prevention a national priority. "We don't have any kind of coordinated system. We don't have continuity, and CDC can only provide cajoling and counseling to the states. It's not a command-and-control structure."
This year's shortage emerged earlier this month when Chiron Corp. one of two makers of flu vaccine for the United States was barred from supplying any of the expected 48 million doses because of problems at a manufacturing plant in Liverpool, England. The action is expected to halve the United States' supply of flu vaccine.
Approximately 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.