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The Blame Game
I am very disappointed. After spending BILLIONS of dollars, if this is a test of our country's response to the H1N1 influenza pandemic, then God help us...
Not Enough Vaccine
The government blames the manufacturers (vaccine producers). The manufacturers blame the virus. The patients blame me! The government said that the manufacturers failed to live up to their promise of sufficient doses at a certain time. We were supposed to have about 40 million doses available for distribution, but for a variety of reasons (or excuses), only 28 million doses have been released. I have heard that the H1N1 virus grows slower than the seasonal flu virus, as one excuse. Another had to do with changing from the seasonal flu orders to the H1N1 orders (whatever that means). Or, perhaps there was a shortage of eggs because of Easter? Millions of chicken eggs are used in the manufacturing of both influenza vaccines. Sometimes, I feel like I am just being egged along, too. Regardless of the reasons, those of us in the primary care trenches have to turn down requests for flu vaccine every day because we do not have it.
Yesterday, my chickens laid their first eggs - two of them. I would love to send those two eggs to the vaccine makers. They apparently need all the help they can get.
Problems with Distribution
Due to varying populations in each state, the allotment for influenza vaccine, both the seasonal and H1N1, are divvied up. The more populous states, like California, are supposed to get more than say, Alaska. When that big truck filled with flu vaccines arrives, where does it really go? The vaccine is being sent to the State Health Department, I believe, to be distributed down the county health departments. How can large medical groups run out, and the local grocery stores and pharmacies seem to have ample supplies for their flu clinics? I sure wish I knew that answer. We do not have any H1N1 vaccine in our clinic, but there is going to be a school "flu clinic" today in one of the local junior high schools. Maybe I should go, stand in line, and try to get some for my patients? Even as I wrote this blog post (during my lunch hour), an email informed me that we received a shipment of flu vaccine. It may last us the rest of the week.
Deciding Who Gets the Vaccines
I would make a bad triage person - sitting behind the desk in the ER, deciding who goes in first. People always think that the ER has a "first-come, first-serve" policy. They do not. When it comes to flu vaccines, the people most at risk have been identified - health care workers in the trenches; pregnant women, children with pre-existing health problems like diabetes, cancer, asthma, etc.; and, all other children after that. Initially, we were informed that kids from six months to 24 years were the target group. Because of the vaccine shortage, it was modified to kids from 2 to 9. I had an issue the other day that involved two children, ages 7 and 11. According to our clinic policy at the time, only the 7 year old could get the vaccine; the 11 year old had to wait. The mother was not pleased. Today, our clinic received about 500 doses of the seasonal flu, so "anyone" can have it...today, while the supply lasts. We have no idea when we will get the next shipment. Sometimes, bad timing decides who gets the vaccine. If you happen to come in to our office when that shipment arrives, you may get it. Wait until tomorrow, and you may be too late. My heart goes out to person number 501 standing in a line for hours at a flu clinic that only has 500 doses.
Deciding Who Gets Tamiflu
The Feds bought up most of the Tamiflu last year when the Bird Flu was on its way. Millions of doses were sitting in government warehouses waiting for this pandemic that did not occur. Now, the strategic horde of Tamiflu is being released. I suspect it is being released because (a) it is needed, and (b) it has an expiration date and the government wants to dump it. Of particular concern, is the shortage is the suspension form used for children. Currently, pharmacists are compounding the adult doses - grinding them up and mixing this powder with cherry syrup - so we will have antiviral medication for children. One local pharmacist charged one of my mothers an extra $75 to compound her child's prescription. Nice.
According to medical authorities fearful of creating Tamiflu-resistant strains (happening already), the antivirals should be reserved for the more risky patients - the sickest, and those most-likely to develop serious or life-threatening complications. What is really happening, of course, is that Tamiflu is going to those who (a) demand it, and (b) those who have insurance or can afford to buy it. It ain't cheap, and lately, it ain't easy to find. I had two H1N1 cases last night in evening clinic. Both children had high fevers and were very, very sick. I prescribed Tamiflu to both of them. I hope the parents were able to find and get it. I wonder where I would stand, legally, if I withhold Tamiflu for a child with H1N1 who ends up with a serious complication, simply because they are not considered "high risk"? I think we all know that answer.
For you bargain-hunters, it is possible to buy counterfeit (fake) Tamiflu on the Internet, which would certainly be effective if you came down with, say, fake (swine-ish) flu.
Concerns About Safety and Efficacy of the H1N1 Vaccine
It's safe. It's as safe as any other flu vaccine, but I have to spend a lot of time defending it to my patients. True, it is not well-tested, especially in children, but the seasonal flu vaccine is never well-tested. Some parents are leery of all vaccines, thinking any of them, or combinations of vaccines will overwhelm the child's immune system, and cause autism. I find that I have less patience in dealing with these people who rely on rumors and junk-science, instead of hardcore scientific evidence. If they don't want flu vaccines, they will have to endure the risks. I wonder if they only wear seat belts if they suspect they might get into a car accident, or just try and put them on...real fast...when a tractor trailer truck is heading straight for them.
It takes about three months to determine what the seasonal strains might be, and at least another three months to whip up a big batch enough for the population. No sooner than you get the batch all cooked up, bottled, and sent off to distributors so the price can be increased, then you have to start all over for next year's seasonal flu. The H1N1 strain surprised everyone. The companies that manufacture flu vaccine (very few, I might add) already had the seasonal strain cooking then the order came through. In this economy, no one wants to turn down work - even seasonal work - so companies scrambled to take advantage of this lucrative pandemic.
Pharmaceutical companies are not high on the "trust list" for many people, so I can understand the reluctance about not be first in line for this vaccine. So far, after millions of doses given, there have been little, if any, reported adverse effects. Efficacy, of course, will really be tested in the field, but those people who are immunized. I guess you really never know what diseases you DON'T get, but if this pandemic is curtailed, then the program (and vaccine) will be extolled as a success.
I really hate flu season.
Labels: flu, H1N1, influenza, safety, seasonal flu, swine flu, vaccine
6 Comments:
I read contradictions to your own ideas and defense. You say you have less patience for people who rely on rumors because they don't trust the vaccine yet in this article, in earlier paragraphs you say the vaccine is not well tested on childred. What is it? You want people to just believe you blindly? What is so scientific about believing you blindly? I am tired of these so called 'scientist' belittling parents' concerns thinking we are being stupid yet they cannot prove that it is completely safe. I am being smart about what my doctor gives to my child, despite the fact all stupid people around me who are pushing me to make stupid and uninformed decisions.
Good point, but you have to keep in mind that influenza is different. The strains are different every year. They are unpredictable and they rapidly change. Kudos to the CDC for devoting the effort in creating SAFE VACCINES...QUICKLY. When you are dealing with a pandemic, you don't have TIME to test the vaccine on large groups of people, especially children. There is not a parent on this planet that would blindly volunteer their children to test an unproven DRUG, but flu vaccine is NOT A DRUG. Vaccines "trick" the body into believing it had the disease, but creating NATURAL ANTIBODIES against the invading organism. Vaccines unlock the body's natural defenses, not circumvent them. This is one reason why vaccines are infinitely safer than drugs which tend to be alien to the body.
You can take the flu vaccine, or H1N1 vaccine if you want...it is not mandatory. And, you can make those decisions for your minor children. It is normal to be skeptical...and afraid of any new treatment or modality, but that fear alone does not make it unsafe.
I do trust the scientists and experts. Do they make mistakes? Of course, all humans do. Are their intestions noble? Would they give the vaccine to their own children? I have no doubts.
I am desperate for an answer to this question: if your child has had the symptoms of the h1n1 virus, is it safe to give them the vaccine? My daughter has been reluctant (if she could even find the vacine) to get my grandchildren ages 7 and 14 the vaccine. They both had a high fever, and flu symptoms about two weeks ago. My grandson (7) now has been diagnosed with pneumonia, and sent home from the emergency room with an antibiotic. My grandaughter was diagnosed with a severe upper respiratory infection and swollen tonsils and was also given an antibiotic and sent home. I'm scared- the hospital said thats all they can do. Please help.
Yes, you can still take the vaccine. Because we are no longer routinely getting confirmation of the H1N1 strain (mostly because the H1N1 strain is the ONLY strain circulating right now), the diagnosis is often made "clinically" -- based solely on signs and symptoms. I have to tell you that clincal diagnoses are rarely 100% since their are many FLI's (Flu-like Illness) that are not H1N1.
Let's use the chicken pox (varicella) vaccine as an example. Since chicken pox is another notoriously misdiagnosed illness, we often find that people who swear they had chicken pox, do not show any blood antibodies to this disease. We do know that vaccines do not seem to produce lifelong immunity for some diseases; unlike the diseases themselves, so we now give varicella boosters. We we did give a varicella booster to someone who actually had varicella, it would still be safe. You wouldn't be any more protected, but at least you would be more assured that you were immune.
So, if you truly had the H1N1 disease, you are probably immune. However, are you willing to take the chance that you were misdiagnosed since it was made clinically and not confirmed by lab tests (which, incidentally can take WEEKS to come back)? It would be nice to know -- 100% -- if we are immune, either by disease exposure or lab tests, but is often not reasonable to do so. As much as we fear this strain of the flu, the vast majority -- over 99% -- of those who do get H1N1 do NOT have serious complications. It is difficult, if not impossible, to know...in advance...if you or your child will be in that 1% that do. In medicine, there are always risks' always pros and cons to weigh. In the end, people do tend to chose the options that are best for them.
As you know, Allyne, antibiotics will not cure influenza, but in cases where there are secondary (bacterial) infections, like pneumonia or Strep, antibiotics are indicated.
Your daughter's vaccine relucatance is common, but know that the vaccine is safe and appears (so far) to be effective. It's not perfect, but neither is winging it without the protective benefits of the vaccine. All you can do as a Grandmother is to provide accurate information. That is really all that I can do as a medical provider, too.
Counterfeit tamiflu can be identified by using the steps mentioned here, Counterfeit Tamiflu Information
I just read that the U.S. could have had triple the amount of vaccine if the FDA had approved the use of an adjuvant. All the other countries have used adjuvants for years except the U.S. People are standing in line to get this vaccine. We don't have near enough vaccine for everyone who wants to be vaccinated. I hope it doesn't get worse because the people in the U.S. are stupid for not getting vaccinated.
Adjuvants could be used in seasonal flu shots to make them more effective. The FDA is fooling around with people's lives
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