Flu a bigger threat than bioterror

With the announcement that 50 million influenza vaccines from the U.S.-based manufacturer Chiron won't be available in the United States this year because of possible contamination, the Centers for Disease Control has been put in a quandary, its credibility once again damaged.

From pushing the yearly flu vaccine accelerator pedal, it suddenly has had to slam on the brakes. "Take a deep breath, this is not an emergency," Dr. Julie Gerberding, the agency's director, said, trying to ward off a stampede of shot-seekers. But such attempts are bound to fall flat, especially with the elderly, who need the vaccine to protect them from serious illness and death.

One of the main reasons a shortage like this can occur is because drug manufacturers are not eager to produce vaccines in the first place. This is why there are only two major flu vaccine makers -- Chiron and Aventis -- worldwide. Without a patent to ensure high prices, the profit margins for generic vaccines are narrow.

Plus, proper sterilization methods cut further into the profit margin. Forget altruism, or concern for patients; drug companies are not eager to make a product they can't make a lot of money on. The only way to ensure adequate supplies and reserves is for the government to step in and subsidize the manufacturing of vaccines. Yet last year Congress approved only half the $100 million requested to develop better flu vaccines and improve the distribution system.

Instead of worrying about the flu, government has been busy spending millions stockpiling more than a million doses of anthrax vaccine (with no use for it in the foreseeable future) and more than 200,000 doses of smallpox vaccine (without a single case occurring here since 1949). These actions were taken so that the Department of Homeland Security can look like it takes the threat of biological agents seriously.

Fearing an anthrax attack since 2001, Congress has contracted for millions of dollars in vaccine production. Since the vaccine is perishable, and there is no anthrax, most of what is produced is thrown away. Similarly, panicked over smallpox in 2002 and 2003, the government bought 291,400 doses of the antiquated live virus vaccine, which was found to have significant side effects. Ultimately, only 38,549 people were vaccinated and more than 250,000 doses were discarded. Influenza kills about 40,000 people in the United States every year and hospitalizes more than 200,000.

The CDC has asserted that at least 185 million Americans are at sufficiently high risk to warrant their getting the flu vaccine.

As of this writing, the supply of vaccine available this year is only about 54 million doses. The CDC has been begging Aventis to produce more, but the company has agreed to only 1 million additional doses.

Instead of spending all its vaccine money on the production of all but useless bioterror vaccines, the government, through a more prudent flu subsidy, could increase the availability of a vaccine that might actually save lives.

Marc Siegel is a physician. Reprinted with permission from the Nov. 1, 2004, issue of The Nation (www.TheNation.com).

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