Managing Flu Vaccine Shortages

Currently the Centers for Disease Control and Prevention (CDC) is not aware of any known shortages related to the upcoming flu season’s vaccines.¹ “Vaccine manufacturers have projected that they will supply the United States with as many as 173.5 million to 183.5 million doses of influenza vaccines for the 2022-2023 season,” the CDC reported.¹

Alan R. Hinman, MD, MPH, of the Task Force for Child Survival and Development in Decatur, Georgia, and colleagues examined the history, effect, and future implications of vaccine shortages in a research article published in The Annual Review of Public Health. Shortages have occurred in the past, such as in 2004 when the US flu vaccine supply was reduced by half when Chiron’s production license was unexpectedly suspended in Britain.² “The problem was made even more dramatic because many large purchasers (health plans, states) had contracts with only one manufacturer and therefore were in an all-or-none situation with respect to vaccine supply. In addition, Sanofi Pasteur had already distributed just over half (33 million doses) of its 2004 production,” researchers reported.² The study authors reported that other causes of shortages include lack of resources for vaccinations to be purchased, production or supply interruptions, and high demand-- and all of these have played a role in US shortages.2

In the response to case of the 2004 shortage, Hinman and colleagues said that 22 steps were taken in response. First, the Advisory Committee on Immunization Practices (ACIP) prioritized patients with chronic conditions and adults ≥65 years of age, (about 85 million high-risk people) for influenza vaccination, in addition to household contacts of children aged younger than ≤6 months (approximately 6 million people), and 7 million health care workers.² Next, the federal government and state public health departments assisted in distributing vaccine that Sanofi made available for sale and distribution.² This resulted in multi-state cooperation in distributing flu vaccinations. Media campaigns were used to encourage healthy, younger individuals to not get the flu vaccine that season.²

John D. Grabenstein, RPh, PhD, president of Vaccine Dynamics in Easton, Maryland, spoke with Drug Topics® on vaccine shortages. Grabenstein said shipping delays have happened in several years, but indications are that supply will be ample this year. “Delays can be caused by viruses growing slower than usual during early manufacturing steps,” he added. “Since the major disruption of flu vaccine supply in 2004, manufacturers have increased capacity and quality-control steps,” he noted.

If vaccine shortages do occur, what should pharmacists do if stock begins to run low? Grabenstein acknowledged that sometimes there are spot shortages that can be solved by one overstocked site trading with an understocked site. “In the event of a major shortage, for which there is no indication at present, CDC will develop prioritization guidelines which would emphasize vaccinating those most at risk of a lethal influenza infection, which would be the elderly and immune-compromised people,” he said. In the event of a shortage, Grabenstein advised pharmacists to turn to the CDC, the FDA, and state health departments as the primary sources of guidance for next steps.

“We are far enough into the vaccination season that I think we would know of a shortage if there was going to be one,” Grabenstein said.

He went on to emphasize that it is more important for pharmacists to know about the new ACIP preference for folks 65+ years old to receive one of the enhanced influenza vaccines (ie, high-dose or adjuvanted). “Pharmacists should encourage simultaneous influenza vaccination with other vaccines folks need: think pneumococcal, zoster, COVID-19 bivalent, Tdap, et cetera. They should prepare for the conversations that help transform vaccine uncertainty into vaccine confidence.” He suggested resources at vaccineconfident.pharmacist.com.

“Vaccinations should be a year-round service -- essential if tens of millions of American adults are to get caught up on the vaccines they need, so they aren't vulnerable to a preventable serious infection,” Grabenstein said.

References

1. Centers for Disease Control and Prevention (CDC). Seasonal influenza vaccine supply for the U.S. 2022-2023 influenza season. Updated September 16, 2022. Accessed September 20, 2022. https://www.cdc.gov/flu/prevent/vaxsupply.htm

2 Hinman AR, Orenstein WA, Santoli JM, Rodewald LE, Cochi SL. Vaccine shortages: history, impact, and prospects for the future. Annu Rev Public Health. 2006;27:235-259. doi:10.1146/annurev.publhealth.27.021405.102248