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    Friday, November 25, 2005

    The Trouble with Flu Vaccine: The British have been caught short on influenza vaccine, just as we have here in the United States. And the reason is the same - it's hard to predict how much flu vaccine will be needed each season.

    Since 1992, childhood vaccines have been ordered centrally by the department, based on the precise knowledge of how many children there are to be vaccinated. As a result, said David Salisbury, the department?s head of immunisation, there has not been a shortage of stock since 2000. ?The system is managed, controlled, and cost-effective,? he said.

    But flu vaccine is ordered differently. GPs place their own order with the manufacturers, based on their best guess of what demand will be. Calculating how much to order is largely guesswork. All those over 65 are entitled to a free flu jab on the NHS, and about 73 per cent are likely to take it up.

    In addition, all GPs have patients who are under 65 and entitled to a free jab because they have other risk factors ? usually chronic diseases such as diabetes. The take-up in this group is much lower, averaging under 50 per cent.

    Nationally, there are eight million people over 65, and another three million in the younger "at risk" category.

    A GP who over-orders vaccine and is left with some on his hands has to pay for it, but will not be reimbursed by the primary care trust. Over-ordering thus costs a GP practice money, while under-ordering carries no financial risk.

    Peter Holden, a GP in Matlock, said that for every dose of vaccine left, a GP would have to vaccinate ten patients to cover the cost, so the cost of over-ordering is significant.

    In the U.S., childhood vaccines are also ordered by the individual doctor - but they can be kept for a year or more - until their expiration date. It isn't such a big deal if the demand for it is a little short over a few months - the doctor just doesn't order more until his current supply is low enough to warrant it. But flu vaccine has to be ordered months before it's needed - usually in January or February. Overestimating can be costly.

    That's why doctors get so upset to see the flu vaccine getting delivered to grocery store and drug store chains while they're kept in uncertain limbo over the fate of their deliveries. They want to do the right thing by their patients, so most tell their patients to go ahead and get the flu shot wherever they can find it. But for every high risk patient who goes to the grocery store or drug store for their shot, is a dose of unused vaccine in the practice - if and when the vaccine arrives.

    It's a bit of a mess, but a difficult one to clear up since the flu vaccine has to be remade every year to fit the strain that's circulating around the globe.


    posted by Sydney on 11/25/2005 08:51:00 AM 1 comments


    The angle of economics is very telling. 1. The vaccine is still being produced the same way as it had been since, what, 50 years now? It's very "manual" and thus costly product.

    2. The prediction of a strain is a variable that can make or break the bottom line for a pharmaceutical company.

    3. The pharmaceuticals are left with a surplus of vaccines each year, meaning they are losing money even when they get it right and they have enough of it.

    It's clearly a no win situation for any company to develop so much vaccine other than the social aspect and in a bottom line country (world) that's not enough of an incentive.

    By Anonymous Ethics, at 11:24 AM  

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