How long would you stand in line for a flu shot? Not at gunpoint, but voluntarily? Last weekend I had an opportunity to ponder the question.
Both my kids normally get their flu shots by Halloween, despite my daughter’s terror-stricken fear of needles. But this fall, though the husband and I kept saying we were going to track down FluMist, somehow it never happened.
In the New Year, reports of children dying from the flu served as a wake-up call. The vaccine isn’t a magic shield against influenza, particularly if you’re over 65, but it does have protective effects, and it’s safe. For most people, it’s the smart thing to do.
But by the time I called our pediatrician, FluMist, the nasal-spray version of the vaccine, had wafted into the sunset. In fact, our doctor’s office had run out of flu vaccine altogether. A staffer explained they wouldn’t get more because of a shortage.
Stories out of Michigan and Texas have reported local shortfalls. But did that mean there were shortage shortages? Were latecomers like my kids and myself out of luck, with the worst of the flu season still to come? (According to the Centers for Disease Control and Prevention, flu usually peaks in late January or early February.)
Friday, I called my local CVS pharmacy to see if they had doses on hand. The automated phone system had a jolly recorded message. (“Flu shots available every day! Walk in any time.”) But once I talked to a human, I learned the pharmacist didn’t administer shots to young children. They did, however, have a “MinuteClinic” on site, and it was all set with appropriate doses for my kids, ages 8 and 6.
Sunday morning, we climbed into the family van and headed to the closest MinuteClinic. I put a new tiny dollhouse, still in its wrapping paper, on the seat next to my daughter, promising that if she didn’t have a psychotic break inside, the toy would be waiting for her in the car. It was 9:47 a.m.
When we got there, a computer screen at a sign-in kiosk informed me the clinic was out of flu shots. We drove to another MinuteClinic, only to come up empty-handed again. My husband, who had to work that day, bailed on us but wisely handed over his Angry Birds-equipped cell phone.
I called four more clinics—taunted each time by the phone message inviting me to get a shot—until I finally found one that still had children’s doses. But it was first-come, first-served. We got back in the car for the fourth time, my daughter staring longingly at the toy next to her and saying, “I hope I get my flu shot soon.”
When we arrived at 11:43, I imagined this MinuteClinic as nirvana, where we would be protected from what is shaping up to be the worst flu season in a decade. But we ended up 15th on the list, with one nurse on duty and children littering the carpet in front of the clinic. Were there enough doses left? I began polling people as diplomatically as possible on their medical conditions. Perhaps they were just sick and didn’t need a vaccination today?
CVS says the chain has already administered more than 3 million doses of flu vaccine this season, up about 50 percent from last year. That’s quite a bump in delivery, yet RAND researcher Lori Uscher-Pines says that U.S. pharmacies still provide far fewer vaccinations than doctors’ offices.
For my family and other slackers, the pediatrician was no longer an option. We were stymied by a system in which everyone has to guess far in advance how much vaccine is needed without knowing what a given flu season will look like. If a medical practice buys too many doses, it ends up eating the cost of the unused supply. So some years they won’t have enough.
A key issue, according to Uscher-Pines, is that the process of creating vaccines is not just long but unpredictable. We’re using antiquated 1950s technology to culture and grow vaccine in eggs—it’s a little like planting a crop. So manufacturers, who have a low profit margin to begin with, start a delicate process several months ahead of each season. By the time we have a clear picture of demand for vaccine, supply is fixed. We just have to hope that we don’t get a lousy harvest during a year when a devastating flu strikes.
There are options available in true crisis years. Beginning in 2004, the CDC created an emergency stockpile for children. Five years later, during the swine flu epidemic, the government centralized vaccine distribution on an emergency basis. But for now, except in that kind of crisis, once doses are out in the world, there’s no system in place to reallocate them in the event of spot shortages.
As long as vaccine production methods remain more or less the same, responding to surges in demand for flu vaccine will continue to challenge public health planners. And doctors may find they’re unable to provide shots for patients come January.