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Although new vaccine supplies are expected to alleviate shortages by this summer, hospitals are being urged to develop contingency plans to handle future problems.
Hospitals should identify priorities for immunization, making sure that health care workers who work with the highest-risk patients have received their recommended vaccines, says Larry Pickering, MD, FAAP, senior advisor to the director of the National Immunization Program at the Centers for Disease Control and Prevention (CDC) in Atlanta.
Those plans would indicate who should receive the vaccine in the case of a moderate shortage, and who would receive the available doses in the case of a severe shortage, he says.
The shortage of the influenza vaccine in fall of 2000 was a harbinger for more widespread problems with vaccine supply. Last year, manufacturing difficulties led to a delay in the distribution of the flu vaccine.
Meanwhile, stricter regulation of the manufacturing process by the Food and Drug Administration forced vaccine makers to make improvements that delayed production. Fewer manufacturers are producing vaccines; in some cases, there is only one manufacturer.
- "When you only have one manufacturer of a vaccine, that can wreak havoc when something happens to the manufacturer," Pickering says.
Shortages occurred this year in numerous vaccines, including: varicella; combined measles, mumps, and rubella; pneumococcal; diphtheria, tetanus, and pertussis; and tetanus. Shortages of hepatitis B vaccine have been localized, Pickering says. Several agencies, including the General Accounting Office and the Institute of Medicine, are studying the shortages and considering what measures could prevent them in the future.
"It’s multifactorial," he says. "There are all sorts of problems. There are lots of things we need to fix."
Amid the shortage, interim recommendations from the Advisory Committee on Immunizations Practices (ACIP) still emphasized the importance of immunizing health care workers. For example, although the CDC advisory panel recommended delaying the varicella vaccine for children ages 12-18 months, health care workers were still in the highest priority category for receiving the vaccine.
CDC officials say they hope the new focus on vaccines ultimately will lead to better supply and more widespread immunization.
Manufacturers have already begun making the influenza vaccine for the next season. The 90 million doses will represent a substantial increase in supply. "The hope is that all the manufacturing problems have been solved and we will get it out on time," Pickering says.
(Editor’s note: CDC is providing weekly updates of vaccine supply at www.cdc.gov/nip.)