May 24, 2010
by Stephen Smith
Roughly 65 million doses of swine flu vaccine sit unused or expired in clinics, doctor’s offices, and warehouses across the United States as the virus that once stoked fears of a devastating global epidemic has retreated. Most of the leftover shots and nasal spray, about 40 percent of what the federal government ordered, will be destroyed.
The purchase of so much vaccine, at a cost of $1.6 billion, was a calculated gamble made early in the epidemic, when it was impossible to know the virus would prove less harmful than some specialists had forecast.
But the gamble may have yielded dividends nonetheless, disease trackers said: The 91 million doses that were administered may have helped prevent a wintertime outbreak.
“Influenza’s just very unpredictable,’’ said Dr. Susan Lett, medical director of the state Department of Public Health’s immunization program.
Massachusetts alone accounts for 1.3 million to 1.5 million unused doses, with no large immunization campaigns scheduled and with the respiratory virus, known scientifically as H1N1, responsible for few medical visits in recent weeks. Health departments in the five other New England states told the Globe they have a total of at least 730,000 remaining doses.
The big surplus, flu specialists said, illustrates the need to accelerate the process for making flu vaccine, which has been done the same way for decades. Because it took months to manufacture the vaccine, swine flu peaked before most shots and nasal spray had been shipped.
“Putting vaccine into production is like trying to turn a big ship around on a dime,’’ said Dr. David Ozonoff, a professor at the Boston University School of Public Health who presides over an online flu encyclopedia.
Long-standing critics of the government’s use of emergency powers in health crises said the vaccine surplus suggests an overreaction to an uncertain threat.
“It’s basically the taxpayers who will be paying for all of those doses,’’ said Bob Dwyer, a district coordinator of the Liberty Preservation Association of Massachusetts. “I don’t feel I should have to pay for it.’’
Early reports from Mexico, where the first swine flu cases were identified in April 2009, suggested that the disease could prove highly lethal, especially to children and young adults.
Those accounts, combined with the swift spread of the virus to the United States, fueled fears of a major outbreak that could have imperiled people whose immune systems had no natural firepower against the novel virus.
Federal disease trackers had to decide within weeks whether to brew a vaccine specifically targeting the virus, an antiquated task relying on chicken eggs that can take as long as six months.
Government flu specialists decided that they had no choice, that if they failed to act and the virus started killing people by the millions, they would be tarred for inaction. So they ordered tens of millions of doses.
They knew it was a race against the clock. Cases waned last summer, but history suggested that a second, possibly more potent wave would land in the fall.
“We know for a fact that flu vaccine saves lives, particularly those at high risk for the serious complications,’’ said Tom Skinner, a spokesman for the US Centers for Disease Control and Prevention.
That second wave did arrive, peaking in late October and early November. But vaccine was a scarce commodity then. It took longer to produce than drug companies originally predicted.
Its use was initially restricted to children and adults considered at greatest risk of complications from H1N1, and that included people unaccustomed to getting flu shots: young adults.
At the same time, most of the elderly, historically a major focus of seasonal flu campaigns, were told they would have to wait for swine flu shots.
With the passage of time, it became evident that while swine flu was widespread and capable of killing, it would not cause the sort of upheaval spawned by the flu pandemic of 1918 and 1919, when millions died globally.
The latest federal estimates show that 61 million people in the United States have been infected with the H1N1 virus, and about 12,000 have died.
Studies estimate 36,000 people die on average each year from seasonal flu.
Once swine flu vaccine became more plentiful in late November and December, the public’s desire to be vaccinated was flagging.
“People felt a decreased sense of urgency about being vaccinated as they saw the mortality estimates be lower than earlier predicted,’’ said Dr. Paul Biddinger, an emergency preparedness specialist at the Harvard School of Public Health.
A Harvard study published in this week’s New England Journal of Medicine found that safety concerns also tamped down demand, though no significant complications have been reported.
Still, in Massachusetts, about 2.3 million doses of H1N1 vaccine were administered, comparable to what has been given the last few years for seasonal flu.
A feared third wave of swine flu has not materialized. Maybe, specialists said, it is because enough people became immune through vaccinations and natural exposure to the virus. Or maybe, they said, widespread campaigns admonishing people to cover coughs and sneezes and to use hand sanitizers has paid off.
The CDC is implementing a plan allowing doctors to return expired vaccine, with the federal government absorbing the cost. Massachusetts authorities are asking physicians with vaccine that is still good to hold onto it until the arrival of immunizations for the next flu season.
“Just in case there’s a problem with the seasonal vaccine,’’ said Donna Lazorik, the state’s adult immunization coordinator.