Better Shot at Prevention

Posted Dec. 17, 2009, at 5:59 p.m.

Maine now has enough H1N1 vaccine for anyone who wants it — after federal officials announced that the flu had abated in this region. Tuesday, one vaccine maker announced a recall of the version of the inoculation made for infants, because it wasn’t strong enough.

What to make of this debacle? The problems with the H1N1 vaccine highlight the shortcomings of the current production and distribution system. Looking for ways to fix those problems now should be a priority before the next outbreak of a novel virus.

Problems began almost immediately. The first was a shortage of vaccine, prompting long lines at vaccination clinics. The shortage continued even as the death toll from the H1N1 flu climbed.

Although federal officials pledged 160 million doses of vaccine by October, fewer than 30 million were produced by then. The antigen, it turned out, grew slower than expected and was weaker than necessary. Both problems meant it would take a lot longer to produce sufficient quantities of vac-cine.

Maine only began receiving enough of the drug to vaccinate the general population in recent days. Seventeen deaths have been confirmed as attributable to H1N1 in the state. In all cases, multiple underlying medical conditions were a factor.

Then, this week, Sanofi Pasteur announced it was voluntarily recalling 800,000 doses of vaccine for children between 6 months and 3 years old — a moot point because most of the shots had already been administered. The pre-filled syringes contained vaccine that had lost its strength, although officials said another dose was not necessary. This only added to the confusion and frustration surrounding the H1N1 flu.

U.S. officials have long known about weaknesses in vaccine production. In 2004, the amount of vaccine against the seasonal flu was cut in half when a British plant was shut down due to contamination.

This year’s problems have nothing to do with contamination or improper operations, but they again highlight the consequences of relying on private facilities, mostly in foreign countries.

Sen. Susan Collins raised these and other concerns in a recent hearing on H1N1 held by the Senate Homeland Security and Governmental Affairs Committee. In a letter to Health and Human Service Secretary Kathleen Sebelius, the senator asked what the department was doing to shift to cell-based production of vaccines and how quickly this would occur. She also asked about policy changes to ensure that the U.S. can manufacture vaccines domestically to ensure an adequate supply for Americans.

Sen. Olympia Snowe, in a letter to Secretary Sebelius, wondered why, three years after Congress approved $5.6 billion for improved vaccine production technology, the U.S. still relies on chicken egg technology.

Part of the problem is economic — vaccines aren’t as profitable as other medications. This points to the need for more government involvement in vaccine production. On the other hand, in some years millions of doses of flu vaccine go unused because the flu season is mild and fewer people choose to get vaccination. These unused vaccines represent a large expenditure for little gain, something that some may find hard to justify.

Given the confusion surrounding H1N1, finding better ways to produce vaccines should be a priority.

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