Outside View: Flu Vaccine Crisis or Not?
By Elizabeth M. Whelan
Outside View commentator
Published 10/27/2004 2:08 AM
WASHINGTON, Oct. 27 (UPI) -- Secretary of Health and Human Services Tommy Thompson last week declared the sudden shortage of influenza vaccine in the United States is "not a health crisis." He argued that anxious people should be patient while the government works to reallocate the nation's limited supply of vaccines.
To his credit, Thompson was trying to prevent panic -- and prevent the long lines of flu-shot seekers seen increasingly on the nightly news.
Let's call a spade a spade, however. The Merriam-Webster OnLine dictionary defines "crisis" as "an emotionally significant event or radical change of status ... especially one with the distinct possibility of a highly undesirable outcome."
A review of the statistics makes it clear that even if the 36,000 flu-related deaths we are accustomed to seeing annually is not a crisis, this year's situation is.
Statistics from the Centers for Disease Control and Prevention in Atlanta indicate 90 million people in the United States are considered at high risk for influenza and its complications this year -- and thus are on the CDC target list for getting the immunization.
This group consists of people 65 or older (35.6 million), those age 2 to 64 with chronic illness (39.4 million), pregnant women (4.0 million), children ages 6 to 23 months (5.9 million), healthcare workers under age 65 (7.0 million) and household contacts of those under age 6 months (6.3 million).
A second tier of "target" population includes a broader group of those who have household contact with high-risk people age 2 to 64. Combining these two risk tiers yields a total target population of 187 million people at higher-than-average risk of flu.
Even sticking with just the top priority risk group -- 90 million who need shots -- the current supply (about 60 million doses) is by no means adequate.
Second, it has become obvious that we will have to prioritize further who is at the highest risk among those in the overall high risk group, now that half of the supply of flu vaccines is contaminated and thus unavailable.
Given that more than 90 percent of the 36,000 flu-related deaths last year occurred in the elderly, those older than 65 are considered first in line to get a shot. Last year, about 66 percent of that age group were vaccinated. If that percentage increases significantly due to the prevailing anxiety -- which may prompt older people who do not regularly get the flu shot to seek one this year -- perhaps as much as 90 percent or about 32 million doses of our 60-million-dose supply would be used by the elderly.
This would leave approximately 28 million doses for 55 million other top-tier, high-risk people, including those with chronic heart, lung and other diseases; those with HIV infection and other debilitating conditions; pregnant women, young children and healthcare workers. The bottom line is there inevitably will be about 30 million high-risk people in the United States who will be denied immunization.
With all the publicity about the shortage, it appears that we do indeed have on our hands "an emotionally significant event or radical change in status ... especially one with the distinct possibility of a highly undesirable outcome."
It is a crisis, but just because it is a crisis doesn't mean we need to panic. We just need a reasoned game plan.
What are we to tell those 30 million high-risk people who are worried because they or their loved ones cannot be protected from flu this year?
What do we tell the parent of a 16-month-old child (or a pregnant woman, asthmatic, physician or nurse) who cannot be vaccinated because there is no vaccine left?
If on one hand we say "don't worry, everything will be fine, your health is not in jeopardy," we understandably will be accused of doublespeak.
How can we tell high-risk people one day they need a flu shot to protect their life and health and then tell them the next, "It's OK, you'll be fine," when the only thing that has changed is the availability of vaccine?
If we tell these high-risk individuals they need not fret about not getting their flu shot this year, because serious illness and complications are not likely, how do we credibly tell them to get immunized to protect their health next year?
Physicians and public health professionals have to walk a very narrow line. We need to avoid panic at any cost while also telling the truth.
Here is what we should advise people under age 65 who have been told they are at risk but cannot get a flu shot:
-- More than 90 percent of the serious complications of influenza occur in people over 65. You are not in that age category and although you (or your child) may be at higher risk than most for complications, the risks are relatively small. If you did have a flu shot, your risks would be even lower, but the overwhelming odds are if you do get the flu, there will not be major negative consequences.
-- If you are in the non-elderly, high-risk populations you should know that rates of vaccination last year were relatively low among people with chronic illness (28 percent), pregnant women (12 percent), babies (30 percent) and healthcare personnel (38 percent). Yet, more than 90 percent of deaths and hospitalizations from flu complications occurred in the over-65 age group, not these other groups (in whom we did not see substantial numbers of deaths or serious illnesses).
-- There are some things you can do to protect yourself: Wash your hands frequently, stay away from people who are coughing and sneezing, and avoid crowded areas as much as possible. If you do get the flu, ask your physician if any of the FDA-approved, anti-viral drugs are appropriate for you -- and beware of quacks seeking to profit from your fear.
-- Yes, there likely will be an increase -- perhaps a significant one -- in the number of cases of flu this year, given that 40 million people in the United States who otherwise might have been immunized will not be. Another way to look at this is 25 million fewer people will be vaccinated this year than last year and thus are more vulnerable to the flu. The chances of getting the flu or getting a more severe case are now increased because people have not been immunized. Having the flu is debilitating and inevitably will lead to increased loss of productivity. The flu can make a person miserable for a few days or a couple of weeks, but the overwhelming majority of people who get flu recover from it quickly.
-- Although it may be of little immediate comfort to you -- the "worried, unvaccinated well" -- there may be an ironic silver lining to this year's flu crisis: If more older Americans get vaccinated, the overall death rate from influenza could be lower this year than it was in recent years, because those in the most at-risk-age category will have been protected. That is, sickness in the overall population may be greater, while those most prone to die from the flu are more likely to receive vaccinations than in a normal year.