Some elderly and disabled people eager for a flu shot this winter have been frustrated because they couldn't get it where nearly half of patients usually do: from the family doctor.
Many physicians complain much of this year's vaccine went to supermarket and discount chains instead of medical clinics. That's a problem for some people who are most at risk of life-threatening flu complications but aren't always healthy enough to wait in store lines.
Consider Ramon Perez, 64, a quadriplegic who previously used a wheelchair but has been bedridden since the flu two years ago triggered pneumonia, bedsores and other complications.
"I'm so susceptible to getting the flu, so it's important that I get (the vaccine)," said Perez. But his doctor had none, so Perez, nervous about a health aide or visitor infecting him, had to wait until the doctor finally got some doses last month and came to his Woodbridge Township home to give him the shot.
For thousands of Americans, especially those who are healthy, a flu clinic at the local drugstore or discount chain is easier and faster than making an appointment to see the doctor. However, doctors say chain stores don't necessarily give priority to the nearly 90 million Americans considered at high risk of flu complications. They also say it's often better for those patients to see their doctor, who can check their blood pressure, medications and other concerns.
A survey by the New Jersey Academy of Family Physicians found two-thirds who responded had received little or no vaccine by December, but 90 percent saw local stores giving shots. Frustrated, 10 percent said they'll stop giving flu shots altogether and 35 percent are considering it.
Making a profit
In California, one of seven states where the CDC is reporting widespread cases, Dr. Eric Ramos of the Orangeburg Medical Group in Modesto said he suspects pharmacies and chain stores made a profit by charging $25 per flu shot, 2 1/2 times the wholesale price per dose. For some of his elderly patients, who normally get the shot for a $9 insurance copayment, $25 is unaffordable, said Ramos, president of the California Academy of Family Physicians.
"We had none to offer, not one dose, week after week," as patients kept calling, Ramos said. "In the meantime, all of the pharmacies, the major stores were offering vaccines."
In Cranford, N.J., many patients with heart disease, immune system problems, diabetes and the like had to be referred to the local grocery store or never got a flu shot, said Dr. Robert Eidus, who got one-fifth of the doses he ordered just a few weeks ago.
"The vast majority of doctors I've spoken to never got any or got only a limited order," he said.
Because of such complaints, the American Academy of Family Physicians is investigating. "Patients are really frustrated," said president-elect, Dr. Rick Kellerman. "They're upset with the doctors for not having it."
Dr. Ardis Hoven, a member of the American Medical Association's board of trustees and an infectious disease specialist at University of Kentucky College of Medicine, had to send many high-risk patients to a county health department because her clinic's order arrived about five weeks late.
"If we were to have any outbreak now, you probably have a high-risk population that's not immunized," she said.
The Centers for Disease Control and Prevention said about 88 million shots will have been distributed by the end of January, more than in many normal years.
But vaccine manufacturers and distributors say a big factor has been problems for a second year at Chiron Corp., one of the major vaccine suppliers. Last year, the same company was barred from shipping nearly half the U.S. supply because of contamination at its British factory.
Chiron spokeswoman Alison Marquiss said the company's production was late and about several million doses short. She said U.S. capacity should be back to normal by next flu season.
Medical groups and public health officials are so concerned about distribution problems they have made it a prime topic for their annual flu vaccine summit set for later this month.
"Some physicians have had extraordinary difficulty" getting vaccine, said Glenn Nowak, spokesman for the CDC, which is studying the matter.
Meanwhile, flu season, which often peaks in February, has been picking up around the country. Roche Pharmaceuticals said Wednesday it is increasing shipments of its Tamiflu medicine to hard-hit areas. And Sanofi Pasteur, the other large vaccine supplier for the United States, has told doctors it will start taking orders for next flu season on Jan. 31.