Perspective

Flu Shortage—Who Cares?

By Carol Kemper, MD

Isn’t it amazing how people don’t want something until they cannot have it. This year’s nationwide shortage of flu vaccine, caused by manufacturing problems at the Chiron facility in England, has generated more bellyaching, finger pointing, and outright panic than is justified—it makes one almost wonder if the shortage was just an attempt to get people to want the flu shot. Let’s put this in perspective. Every year, hundreds of thousands of doses of flu vaccine go unused and are destroyed, as the Public Health Service and healthcare providers urge patients to get vaccinated. At best, ~65% of the elderly and at risk patients receive the flu vaccine. Last year, when flu vaccine was offered free of charge to patients in our hospital, about 30% refused.

People need to understand some basic information about the flu shot: vaccination against the flu offers only partial (~70%) and temporary protection against a few flu viruses. In contrast, the natural immunity one develops from actual infection is much broader and more durable, lasting an estimated 3 to 5 years following infection. Every year, influenza experts meet to determine the composition of the following year’s influenza vaccine, which amounts to little more than a crapshoot. The vaccine usually contains 3 strains of virus: 2 type A strains and 1 type B strain. For the 2003- 2004 flu season, the trivalent influenza vaccine included A/Panama/2007/99 (H3N2)-like antigen, A/New Caledonia/20/99(H1N1)-like antigen, and B/Hong Kong/330/2001-like antigen. Last year, it was estimated that only 10-14% of those who received the flu vaccine were protected against the strain of flu they were exposed to. This year’s vaccine is identical.

I’ve overheard perfectly healthy 30-year olds complaining they cannot get vaccine—although they look puzzled when you ask them if they’ve ever received one before. One mother was furious that her 4-year-old was denied a vaccine by her pediatrician—until I pointed out to her that that was a good thing; it meant her child was healthy and not at high risk for complications of the flu. Interestingly, the mother desperately explained the child really need the vaccine because she’d had the flu last year—and did not understand the child probably already had much better immunity than any vaccine could provide.

Most likely, there will be enough vaccine for those high-risk patients who may benefit the most from vaccination. The print and mogul media have a responsibility to quell peoples’ fears of epidemics and shortages, provide the public with accurate information about the flu shot, and encourage healthy people to pass on vaccination.

Dr. Kemper is Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, Calif.