The threat of an avian flu pandemic may have captured the attention of the American people, but the healthcare system still needs to brace for the annual arrival of seasonal influenza. Each year, influenza kills tens of thousands of people in the United States. And in an effort to help reduce that grim toll, a group of the country's top influenza specialists came together in Washington, D.C. recently to highlight their plans for the upcoming flu season.
The late May gathering of flu experts — brought together by the National Foundation for Infectious Diseases — outlined a new game plan to significantly increase the country's supply of flu vaccine, add new incentives to encourage more immunizations and push for new and better technology while encouraging healthcare professionals to do a much improved job at immunizing not only target groups, but each other.
"Getting higher rates of immunization is critical to limiting influenza," says Dr. Cristina V. Beato, principal deputy assistant secretary of health in the Department of Health and Human Services. "The public has grabbed on to a pandemic, but they're overlooking the big human and economic cost of influenza each year."
For its part, the Centers for Medicare and Medicaid Services is bumping the reimbursement rate for flu shots from $8 to $18 to encourage more physicians to urge elderly patients to get a flu shot. The government has also provided more than a billion dollars in new contracts to foster the development of new cell-based vaccine manufacturing operations in the hopes of building a system that can roll out new vaccines at a much faster pace than current egg-based techniques allow.
Many doctors understand only too well the stakes involved in preparing for a new flu season.
"We know that vaccination works, it decreases the death rate among fragile patients," says Dr. Ardis Hoven, who represented the American Medical Association at the roundup of flu experts. High-risk patients typically rely on their physician to give them a flu shot, he adds, while younger people are often likely to get a shot at work.
But despite doctors' leading role in the fight against the flu, only 40 percent of healthcare workers get a flu shot each year.
Hand washing or covering your mouth with a Kleenex when coughing and then throwing it away are simple measures that can help stop the spread of influenza, says Beato, "but providers should get vaccinations early on."
"We are not doing a very good job of getting the message out there," says Hoven. "Healthcare facilities have got to make it easy for their employees to get immunized." That means using mobile carts to hand out vaccinations, urging healthcare facilities to immunize workers for free and making sure that all of the vaccine on hand is put to use.
Because vaccine deliveries occur throughout the flu season, healthcare professionals also need to understand that the vaccination season should be extended and patients should be urged to get vaccinations through December.
Above all, doctors should understand that they need to be a positive role model for everyone.
"If I don't take a flu shot," asks Hoven, "should I expect my patients to take a flu shot?"
In order to get everyone immunized, says Dr. Jesse Goodman, director of the FDA's Center for Biologics Evaluation and Research, we also need to avoid any interruptions in manufacturing new vaccines for distribution in the United States. Each year, researchers have to identify which strains of influenza threaten us and determine which vaccine is most likely to protect us. Fresh vaccine supplies have to be made each year.
Sanofi-Aventis, Chiron and GlaxoSmithKline — which recently completed its acquisition of Chiron — all have been approved to supply inactivated forms of vaccines. MedImmune, meanwhile, is the only authorized manufacturer of a live virus vaccine, FluMist®, which has shown signs of activity against multiple strains of the influenza virus.
Health officials recommend that doctors suspend the use of amantadine and rimantadine until new data shows they're effective. Oseltamavir and zanamivir have been approved for use against influenza A and B in different age groups.
But the nation's health system relies on an inconsistent supply process that often interferes with the efficient distribution of the new supply of vaccine.
"Supply and demand are not in sync," says public health researcher Christine Layton, PhD. "Peak demand (in the fall) is when only about 50 percent of the vaccine has been delivered.
"Chiron will only deliver through a wholesaler, while Sanofi will deal direct" to providers, adds Layton. "The actual number of wholesalers who deal in vaccine is not fully known. It's about 26, but that's conservative because there are others that are redistributors. When you hear about price gouging, that usually involves redistributors. Vaccine that goes from the manufacturer to the patient has often changed hands multiple of times."
To help ease supply snafus, she adds, manufacturers are planning to significantly pump up the amount of vaccine that is available. Layton says more than 100 million doses of vaccine should be on hand for the upcoming 2006-2007 flu season.
That won't help fight off a potential avian flu pandemic, the experts note. But with doctors' help, they can lower the annual mortality rates that have become an all-too-familiar seasonal affliction.
