Sunday, October 17, 2004
Coping Strategy For Lack Of Flu Vaccinations
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In discussing the issue of influenza vaccinations with your doctor, you should be aware that there are ways to treat the flu once you get it. One drug is called Tamiflu (oseltamivir phosphate). Relenza (Zanamivir) is another. Tamiflu comes in capsule and oral suspension form whereas Relenza is inhaled via 'diskhaler'. These drugs interfere with the ability of Influenza A and B to aggregate and be released from cells. Both are 'designer drugs' in that their molecular structures were created in the lab specifically for their anti-neuraminidase activity:
""What is Tamiflu used for?
Tamiflu is for treating adults, adolescents, and pediatric patients 1year of age and older with the flu whose flu symptoms started within the last day or two. Tamiflu is also used to reduce the chance of getting the flu in people age 13 and older who have a higher chance of getting the flu because they spend time with someone who has the flu. Tamiflu can also reduce the chance of getting the flu if there is a flu outbreak in the community." "
Though clearly not a substitute for flu shots, their lack of availability makes having a 'Plan B' necessary. If history is any guide, Tamiflu and Relenza will become commodity drugs just like ciprofloxacin was after the Anthrax scare.
Rush Limbaugh Is Playing The Blame Game
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Michelle Malkin has a quick note on the flu vaccine shortage, and points to a Rush Limbaugh piece: Clintons Ruined Vaccine Industry. Rush basically argues that it's all Hillary's fault because of her role in the Government Vaccine Buying Program. This is a classic case of hindsight bias; the tendency of people with outcome knowledge to exaggerate the extent to which they would have predicted the event beforehand. Yes, I'm sticking up for Hillary here. It IS a powerful example of why the approach taken by the vaccine buying program is flawed. What we should be doing is asking ourselves whether we need to make changes vis-a-vis our other vaccine programs.
The October 14, 2004 Wall Street Journal editorial 'Infectious Politics' (reproduced here) has some disturbing statistics:
- Hib1 3
- Influenza 2
- Hepatitis A 2
- Hepatitis B 2
- DTaP2 2
- Measles, mumps, rubella 1
- Tetanus 1
- Tetanus-diphtheria 1
- Polio 1
- Chickenpox 1
- Pneumococcal conjugate (children) 1
- Pneumococcal polysaccharide (adults) 1
- Meningococcal 1
and asks the question:
" "Whether or not Chiron disclosed enough about its manufacturing woes is an issue of financial regulation. The main question for public health ought to be how did we arrive at a place where closing a single plant can endanger so many people?" "
Let's stop playing the blame game and figure out how to improve our vaccine production system. To again quote the WSJ piece:
" "There's no shortage of ideas for how to promote greater vaccine production, with many of the best ideas coming from the few manufacturers that remain. Now would be a good time to hear them out. As deadly as the flu is, consider the dangers of such infectious diseases as measles or whooping cough. Those are the next outbreaks to worry about if Washington keeps blaming everyone but itself for the vaccine crisis." "
Lancet: Summary of Flu Vaccine Woes
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The Lancet: Vaccine preparedness, or not:
The problem
" "So, what went wrong at Chiron's production plant in Liverpool, UK? On Aug 26, according to Chiron, Serratia marcescens was found in a "small number of lots". The company informed health agencies in the UK and USA, and planned to delay release of the vaccine until early October while it tried to resolve the contamination issue. S marcescens is an important human pathogen because of the growing number of cases of infection by this organism, its virulence, and its increasing resistance to antibiotics. MHRA visited the Liverpool site, and Chiron thought it could address the concerns of the inspectors. The problem, says MHRA, is that the contaminated lots cannot be separated from the whole batch." "
The lesson:
" "There is a lesson here, about vaccine supply. It is not sensible to restrict manufacturing licences, in the case of influenza vaccine and especially in the USA, to two suppliers. At a blow, half this year's stocks were impounded. The risk (of faulty batches) should be spread across several manufacturers." "
Saturday, October 16, 2004
Vaccines: The Long Run
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Vaccines: The Long Run:
" "Yesterday I discussed some of the reasons for the current shortage. Today, I will discuss an important paper by Michael Kremer and Christopher Snyder. Kremer and Snyder argue that for the same cost and effectiveness drugs are more profitable to produce than vaccines. As a result, private incentives bias the market against vaccines." "
[Via Marginal Revolution]
Friday, October 15, 2004
Yahoo! News - No Chance of Chiron Vaccine, U.S. Says
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Yahoo! News - No Chance of Chiron Vaccine, U.S. Says:
" "None of Chiron Corp.'s flu vaccine made at a British plant is safe, which means the U.S. flu vaccine supply will be half of what was expected, U.S. health officials said on Friday." "
Serratia contamination.
Yahoo! News - Fines, Jail Used to Enforce Flu Shot Rules
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Yahoo! News - Fines, Jail Used to Enforce Flu Shot Rules:
" "As the vaccine shortage hits home and long lines queue around the supermarket, a handful of states and the nation's capital are threatening doctors and nurses with fines or even jail if they give flu shots to healthy, low-risk people.
Health care violators in Michigan face a misdemeanor punishable by up to six months in jail and a $200 fine if convicted, the health director said.
At least four other states %u2014 Massachusetts, New Mexico, Oregon and Wisconsin %u2014 and Washington, D.C., have issued similar orders with varying penalties." "
Thursday, October 14, 2004
Vaccines: The Short Run
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From a new weblog I discovered today:
Vaccines: The Short Run:
""President Bush was correct when he said that liability risk is one factor in the recurrent shortage of vaccines...
...
[snip]
...
Liability is not the only issue, however. Costly FDA regulations and requirements, for example to remove thimerosal from vaccines despite no evidence of safety problems, have pushed firms out of the industry.
A further problem is that the federal government is the major purchaser of vaccines, although not the flu vaccine, and it uses its monopsony powers and the law to require companies to sell at low prices. Firms have left the industry because they are squeezed on one end by regulation and on the other by low prices and, for vaccines like the flu vaccine not covered by VICP, potential liability. Note that even if the prices are high enough to earn the company a modest profit the point is that they are not high enough to make it worthwhile to make a surplus of vaccine that can be sold in the event of a contamination problem, as has happened this year. If the firms can't price high during a shortage then there is no incentive to plan for a shortage.""
[Via Marginal Revolution]
Tuesday, October 12, 2004
CDC Posts Interim Guidelines for Influenza Vaccination
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CDC Posts Interim Guidelines for Influenza Vaccination
[Via Medscape Headlines]
U.S. Health Officials Release National Flu Pandemic Plan
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U.S. Health Officials Release National Flu Pandemic Plan:
""The Dept of Health and Human Services recently released its plan to respond to and prepare for an influenza pandemic, detailing domestic actions as well as its role in the global health community.
The Nation's Health""
[Via Medscape Headlines]
Sunday, October 10, 2004
Can We Learn Something From The Flu Vaccine Shortage?
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I hadn't thought of this until Michelle Malkin pointed it out in her excellent weblog:
""Why on earth does the U.S. get virtually all of its flu vaccine supply from just two manufacturers? Because federal bulk purchase of vaccines at government-controlled prices has made the vaccine market a market that few drug companies want to be in.
[snip]
...the flawed approach used by the CDC--that is, using its buying clout to extract deep discounts from manufacturers--is exactly the same approach that John Kerry thinks the Medicare program should use for all prescription drugs, not just vaccines. More on our flawed vaccine policy here and here.""
[Via Michelle Malkin]
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