Pharmacists report price gouging after flu vaccine shortage

The system has to change, say infectious disease experts

In September, health officials had concerns about the severity of the upcoming influenza season. Then Chiron Corp. notified the Centers for Disease Control and Prevention (CDC) in Atlanta on Oct. 5 that it would not provide its influenza vaccine (Fluvirin) for the year because of contamination issues. This essentially cut the nation’s trivalent inactivated vaccine supply in half.

Aventis already had distributed about 30 million of 54 million doses of its inactivated flu shot (Fluzone). In addition, government health officials said then that about 1.1 million doses of live attenuated influenza vaccine (LAIV/FluMist) manufactured by MedImmune would be available this season.

The reaction across the country to the news was immediate. Many elderly people stood in line for hours to receive the available doses. Health officials asked that the public voluntarily ration the vaccine by allowing those most at risk for the flu to get the immunization first. Those people include:

  • all children ages 6-23 months;
  • adults ages 65 years or older;
  • people ages 2-64 years with underlying chronic medical conditions;
  • all women who will be pregnant during the influenza season;
  • residents of nursing homes and long-term care facilities;
  • children ages 6 months to 18 years on chronic aspirin therapy;
  • health care workers involved in direct patient care;
  • out-of-home caregivers and household contacts of children younger than 6 months of age.

Some pharmacists who ordered and received their flu vaccine from Aventis considered themselves fortunate. Tim Stacy, RPh, MBA, system director of pharmacy at Children’s Healthcare of Atlanta, says he also received 200 doses of free FluMist to use from MedImmune.

Even with these available doses, however, the vaccine was not given to everyone. "We have decided to vaccinate only patients and direct caregivers," Stacy says. "Pharmacists, being on the patient floors, will get vaccinated. Office workers will not."

In contrast, Huntsville Hospital in Alabama has about 5,000 employees and only about 2,000 doses of the flu vaccine available for use. A priority list has been made in which the emergency department and intensive care unit employees receive first priority due to their close contact with patients and the severity of the patients’ disease states, says PharmD candidate Andrea Pierce. Next priority are oncology areas, radiation, respiratory care unit, progressive care units, cardiac recovery, postoperative floors, and pediatrics.

The remaining doses will be divided among the caregivers in other critical departments, she says. "Medical staff (except for physicians), volunteers, and family members will not be given the flu vaccine by Huntsville Hospital."

The price gouging begins

Many pharmacists found themselves at the wrong end of distributors trying to profit from the shortage. A flu vaccine pricing survey, conducted by the American Society of Health-System Pharmacists (ASHP) in Bethesda, MD, said that U.S. hospitals of all sizes report being actively solicited by secondary distributors offering the flu vaccine at prices far beyond the original list price.

The society had sent e-mail invitations on Oct. 8 with a link to an on-line survey to 2,561 ASHP members identified as pharmacy directors practicing in the United States. The survey was officially closed early Oct. 13, after a total of 677 surveys were completed, yielding a 26% response rate.

The main findings of the survey include:

  • More than half (55%) of respondents report that opportunistic vendors offering to sell flu vaccine at highly inflated prices contacted them. Of the hospitals contacted by opportunistic vendors:

    — About four out of five respondents report being offered the vaccine at more than four times the original market value.

  • — Nearly 20% have been offered the vaccine at $800 or more per 10-dose vial (more than 10 times the original market value).

  • More than three-quarters (77%) of hospitals noted that they would not have enough flu vaccine available to meet current CDC vaccination recommendations. Further, 84% of respondents reported that they did not plan to purchase additional vaccine on the secondary market at these inflated prices.

Huntsville Hospital’s pharmacy purchasing agent has encountered some price inflation of the vaccine due to the shortage, Pierce says. Prior to the shortage, one vial cost about $80; but now some sources are attempting to charge as much as $600-$1,000 per vial with each vial containing 10 doses.

Scrambling to get more vaccine

After the Chiron announcement, the Department of Health and Human Services (HHS) began scrambling to get more flu vaccine doses. On Oct. 19, HHS Secretary Tommy G. Thompson announced that Aventis would make an additional 2.6 million doses of influenza available in January.

On Oct. 21, Thompson said MedImmune would be providing a total of 3 million doses of FluMist, which is approved for use by healthy people between the ages of 5 and 49 years. The government also has enough antiviral medicine to treat tens of millions of people for flu this season, he said.

On Oct. 28, Thompson announced the potential of getting about 5 million doses of vaccine from foreign manufacturers. Inspectors would soon travel to the manufacturing facilities, he said. The government also had recouped about 300,000 doses of the injectable vaccine originally bought for federal employees and the military.

These additional doses, however, only address the shortage this year. Health officials worry about next year, too. In 1994, five manufacturers produced injectable influenza vaccine: Wyeth, Evans (now part of Chiron), Connaught (now part of Aventis), Parke Davis, and Lederle. Now only Aventis and Chiron remain.

Call for research incentives

The Infectious Diseases Society of America (IDSA) in Alexandria, VA, has renewed its call for Congress and the Bush administration to "implement innovative public policy geared toward removing financial disincentives that have caused pharmaceutical companies to leave the vaccine market."

IDSA has been urging federal policy-makers to create new incentives — such as tax credits, strengthened intellectual property rights, liability protections, or some type of federally guaranteed purchase program — to make the infectious diseases market more attractive to industry, said John G. Bartlett, MD, chief of the division of infectious diseases at the Johns Hopkins University School of Medicine in Baltimore and chair of IDSA’s Task Force on Antimicrobial Availability. Other ideas for making the market more attractive may be worth exploring, he added in the statement.

"Vaccines and antibiotics have been among our chief tools for preventing and treating infectious diseases," says Walter E. Stamm, MD, IDSA president. "How can we as infectious disease physicians tell our patients that our tool box is empty? Market forces alone are not going to solve this problem. We need innovative federal policy to protect public health."