Pharmacists scramble in wake of flu vaccine debacle

Less than 24 hours after Chiron Corp. announced it wouldn't be shipping its 48 million doses of Fluvirin influenza virus vaccine to the U.S. market, rumors of price gouging began to spread. The prospect of secondary suppliers offering the vaccine at higher prices, coupled with potential drug diversion and counterfeiting, has been keeping health-system and community pharmacists on high alert. They are struggling to meet patient demand for a vaccine that by all accounts is likely be in short supply long before the flu season reaches its peak.

Chain, mass-merchandising, and supermarket pharmacies have suspended their flu clinics or are limiting their distribution to high-risk patients as defined by Centers for Disease Control & Prevention guidelines. Among those the CDC recommends for vaccination are the following: children aged six to 23 months; adults aged 65 years and older; pregnant women; and healthcare workers involved in direct patient care.

Walgreens, Medicine Shoppe, and Safeway have been screening patrons to make sure they meet CDC criteria as high-risk patients. Brian Hille, director of pharmacy care for Safeway Inc., said the company has instructed its pharmacists to advise patients to consider FluMist, a live, inhaled version of the vaccine, as an alternative for patients who meet CDC criteria.

Novation, a Texas-based group purchasing organization (GPO) that supplies pharmaceuticals and other products to 1,400 U.S. hospitals, reported that 65% of institutions that purchase through the GPO had preordered from Aventis in the spring, while the remaining facilities ordered from Chiron. A Novation official told Drug Topics that the company is working closely with Aventis to monitor the status of hospital orders as well as the possibility of any additional supply alternatives. Novation has learned that 90% of Aventis doses have been shipped to the hospitals that ordered through the GPO. Members that ordered from Chiron are encouraged to contact Aventis to be placed on its waiting list.

For the nation's hospitals, the flu vaccine shortage could pose a triple threat as they struggle to immunize high-risk inpatients and clinic patients as well as employees.

"The day Chiron made the announcement was the day that we were supposed to kick off our flu immunization protocol," said James Jorgenson, director of pharmacy at University of Utah Hospitals & Clinics in Salt Lake City.

Jorgenson noted that he already has about 6,000 doses of the Aventis product. Among the challenges he faces are concerns about running out of the flu vaccine with lower concentrations of thimerosal, a preservative, which is used for neonates and pregnant patients. He said that upon hearing the news of the cancelled Chiron vaccine, the hospital purchased more FluMist to cover employees. However, because FluMist is a live vaccine that is inhaled, it should not be administered to immunocompromised patients or to employees who come in contact with that patient population.

ASHP is suggesting that its members make every attempt to go through their traditional supply channels using their GPOs and primary distributors to obtain the drug. "They should turn only to secondary distributors with whom they either have an existing business relationship or where they are able to verify the legitimacy of that wholesaler through the board of pharmacy," exhorted Doug Scheckelhoff, R.Ph., director of pharmacy practice sections for ASHP.

ASHP is advising its members to use the CDC criteria and pass them on to their P&T committee as soon as possible, so they could establish an institutional policy on what should be done at their setting. "We don't want to see undue pressure that comes on pharmacy directors to vaccinate patients who may not fall in that high-risk group," said Scheckelhoff.