By now many of us have gotten our doses of influenza vaccine. Now it’s time for a dose of influenza reality. Let’s acknowledge that flu virus is a living thing — and a pretty crafty one at that. Despite all our best efforts, sometimes flu will get the better of us. Depending on your personal experience, you may feel that was the case this year. But in my view, there are a lot of positives to take away from this year’s experience.
Positive No. 1: By the end of 2009, our influenza enterprise will have supplied almost 200 million doses of flu vaccine in the U.S. That will include about 110 million seasonal influenza doses and nearly that many pandemic H1N1 vaccine doses.
That number may feel inadequate this year because we were fighting on two fronts, having to deliver two different vaccines to somewhat different target groups. Meanwhile, we will have proved positive outcome No. 2: We have the capacity to produce more vaccine than the American public usually demands.
While we’re talking about public demand, let’s consider its impact, because that's positive outcome No. 3: Public demand for vaccine is up this year — way up. Right now that means news reports of “shortages” as vaccine supply continues to roll out. But if we can sustain increased demand, we will achieve several important goals: We will protect more people through direct vaccination, we will protect more people by protecting those around them, we will keep more adults at work and more kids at school and we help ensure a better supply for the future.
Increased demand means increased supply. If the public accepts more vaccine, you can bet that the private sector will make it. For good or bad, that’s how our economic system works. The law of supply and demand means manufacturers won’t make more product than they can sell — how can they justify spending on products to throw them away? It’s an American business standard; it works this way across all industries — cars, houses, clothes and yes, even vaccines.
Manufacturers responded quickly
But for the record, here’s positive No. 4: While manufacturers are private enterprises that need to consider profits, they’ve shown great flexibility and willingness to alter their plans and work to achieve goals established by our public health leaders. Companies readied themselves to switch from seasonal to pandemic vaccine production in the late spring and then made the change virtually overnight when asked to do so.
Manufacturers started the H1N1 process in May and vaccine delivery began in October. We all wish we could have as much vaccine as we need on the shelves the moment we need it. But in the case of vaccines, it doesn’t work that way.
Vaccines start from live material — viruses and bacteria that cause us great harm. It takes time to grow these live materials and then to render them incapable of causing any harm themselves. As a result, vaccines are probably the most well-tested and safest medical intervention we have. And to date, they're the only intervention that has led to complete elimination of a disease from the planet. (It's smallpox, in case the ailment doesn’t immediately come to mind).
While I could go on for a while with the positives, here is my last one, positive No. 5: Flu awareness has increased. The Department of Education has asked schools to participate in vaccination programs for our children. This is a tough task for our overburdened schools, but all indications are that they’re doing everything they can to be part of the effort. And that’s good because this particular pandemic flu can hit kids hard. But we also need to remember that seasonal flu also hits kids hard. School-aged children have the highest infection rates and infants and toddlers are hospitalized at rates similar to the elderly because of influenza.
Rising awareness among health workers
Awareness about the need to vaccinate health care workers also has increased. I particularly applaud any efforts to raise vaccination rates in health care workers. We have a duty to do no harm and to be there for our patients. When health workers don’t get vaccinated, we risk failing on two counts. To all those hospitals across the country that have made efforts toward universal health care worker vaccination, I say "Bravo!" We’ve made strides this year and we need to keep at it in the years to come.
Dealing with an unpredictable virus requires aggressive approaches like these. Rapid production of safe and effective H1N1 vaccines is evidence that our years of hard work and effort are paying off. We have acquired an impressive knowledge base, production capacity and vaccine delivery infrastructure. We are poised to make significant strides this year in the fight against seasonal influenza, but keeping this momentum means understanding — and taking — a dose of reality.
Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University, is also president-elect of the National Foundation for Infectious Diseases.