The Flu Snafu

It

isn't hard to understand how the U.S. wound up with a major shortage of flu shots this year. Making the vaccine is notoriously difficult, and the process is prone to production problems and manufacturing delays. In addition, only two companies — Chiron and Aventis Pasteur — were licensed to produce the injections for the U.S. market, compared with five in Britain, six in France and eight in Germany. When Chiron had to withdraw 48 million doses of vaccine in early October because of contamination problems, the remaining 55 million or so doses being made by Aventis simply weren't enough to satisfy everyone who wanted to get inoculated. That set off the panicky scramble for available shots that has drawn so much press coverage in the past few weeks.

What is harder to fathom is why this is happening again. After all, there have been supply problems with flu vaccines for each of the past four years. Several government and academic reports have addressed the issue since 2000, when manufacturing glitches resulted in an almost two-month-long delay in shipments of vaccine. And although the problems have come to a head in the past few years, their roots go back at least two decades. "A lot of people have been asleep at the wheel," says Dr. Frank Sloan, director of the Center for Health Policy, Law and Management at Duke University in Durham, N.C. "There are systemic problems that needed to be ad- dressed and haven't been."

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This being a presidential-election year — in case you hadn't noticed — it didn't take long for the political campaigns to start pointing fingers. John Kerry blamed the President, saying the Bush Administration had ignored repeated warnings that the situation was deteriorating. Bush blamed trial lawyers for driving so many manufacturers out of the market in the first place. But there wasn't much evidence that voters were buying any of it. Although 61% of participants in the latest ABC News poll say they are concerned about the shortage, the issue doesn't appear to be changing their minds about the candidates. "I mean, 40% of the people are going to blame the President for clouds in the sky," Karl Rove, Bush's chief political adviser, told TIME. "But by 3 to 1 and 4 to 1, this argument is being rejected by the country."

Congress turned out to be tone deaf in responding to the crisis. Not long after the Centers for Disease Control (CDC) asked doctors to vaccinate only those at highest risk of deadly complications — people over 65, pregnant women, young children and patients with chronic medical conditions — the office of Dr. John Eisold, the Capitol's attending physician, was still freely dispensing vaccine. Some House and Senate members defended the practice on the grounds they meet a lot of elderly and sick people and shake a lot of hands — despite the fact that both President Bush and Senator Kerry had announced that they, as healthy, civic-minded Americans, would forgo the shots. Only after some Republicans and Democrats protested did Congress decide to vaccinate just those at high risk and donate 3,000 leftover shots to local health services in the District of Columbia.

Determined to put the best face on the situation, Secretary of Health and Human Services Tommy Thompson held a press conference that went a long way toward reassuring the country that the shortage wasn't as bad as it seemed. He announced that government officials were working with their counterparts in other countries — including Canada, of all places — to see if they can buy a few million doses on the international market. For legal reasons, the Food and Drug Administration may have to give foreign vaccines temporary approval as investigational drugs. At the same time, Aventis reported that it should be able to manufacture and distribute an additional 2.6 million doses by January — giving recipients just enough time to build up some immunity before the flu season ends.