US officials debate how to ration flu vaccine

By David Walsh and Alan Whyte
1 November 2004

The revelation that the US Centers for Disease Control and Prevention (CDC) has convened a panel of ethicists to discuss who should receive the flu vaccine in the face of the current shortage is an extraordinary commentary on the inability of American capitalism—in the richest country in the world—to deliver health care to the mass of the population.

According to the New York Times (October 28), the panel began deliberating October 18, tackling such questions as “whether babies should have priority over the elderly in receiving the flu vaccine, or vice versa.” The article continued: “Another question the panel might have to decide is whether, in the event of a pandemic, members of crucial professions—perhaps even undertakers—should receive priority.”

The panel will clearly not examine the “ethics” of for-profit medicine and the practices of the pharmaceutical giants, whose profit drive is responsible for the current shortage. Only 61 million doses are available this year in the US for the vulnerable population—infants, pregnant women, elderly people and those with respiratory problems—estimated to number some 98 million. The figure includes 9 million children, some of whom require two flu shots for the vaccination to be effective.

Approximately 36,000 die from influenza in the US annually, although the total jumps to 51,000 if complications such as heart attack and stroke are included, according to Robert Belshe, director of the Center for Vaccine Development at St. Louis University. Some 200,000 are hospitalized each year because of the disease.

Estimates of the extra number of deaths that will result from the shortage this flu season range from 9,000 to 15,000, and far more if a serious outbreak occurs.

The immediate crisis arose this year when 50 million doses of the flu vaccine produced by one of the two existing suppliers for the US market, Chiron Corp., were adjudged to be possibly contaminated. Suppliers have left the business in recent years because it is not sufficiently profitable, leaving the population dangerously at risk.

The CDC ethics panel is only one of the more grotesque aspects of the flu vaccine crisis. Health departments in several communities—Bloomfield, New Jersey; Newton, Iowa; and Montgomery County, Marlyand—have resorted to a lottery to determine which “at-risk” candidates will receive the flu vaccine—in other words, who will face the prospect of illness or even death.

In Bloomfield, a group of high school students drew lots October 28 to distribute only 300 doses of the vaccine among the township’s 8,000 older people. The winners will be notified by mail. One of the students, 15-year-old Rachel Moseson, expressed doubts about the process: “You’re giving something to somebody, but you’re taking away from somebody else.”

Media outlets in every part of the country have offered accounts of the problems and outright suffering already caused by the vaccine shortage. According to the Associated Press, police had to be summoned in Alabama’s Pike County when tempers flared and “emotions ran high as people jockeyed for a chance to get inoculated.”

In Pekin, Illinois, the first group of more than 650 people stood in line October 28 for more than seven hours, arriving at 1:15 a.m. for a shot that was not given until 8 a.m. And this was “nothing like the long lines and waiting time that plagued an Oct. 21 clinic,” noted the Peoria (Illinois) Journal Star.

The Lorain, Ohio Morning Journal wrote, “Thousands of people, mainly elderly and sick, stood in long lines yesterday at six locations...to get flu shots.” The newspaper cited the comments of a 67-year-old woman who had stood in line for hours and was appalled to see elderly people with canes or walkers or in wheelchairs waiting in line. Delores Costa told the newspaper, “I can stand because I’m healthy. I saw people who couldn’t stand and it makes me sick.” In fact, several people became ill standing in line in Lorain, and two were taken by ambulance to a local hospital.

Massillon, Ohio, was hit by a “flu-shot mania” October 27, according to the local press. The Massillon Health Department administered a record 1,200 flu shots. Some of those on line, waiting as long as six hours, made their resentment known. “My sister was here this morning,” said Barbara Heitger. “She’s voted Republican all her life, but she was so fed up by this she said she’s voting for Kerry.”

Inevitably, in a country so socially polarized, class differences entered into how lines for the vaccine were organized. The St. Louis Post Dispatch reported that outside a Rinderer’s drugstore, nurses and drugstore staff separated the large crowd into two lines, one behind a sign reading “HMO” (Health Maintenance Organization), and one marked “Medicare” (the government program for the elderly). One woman complained, “The people who are HMO people are going ahead of the Medicare people who have been waiting for hours.”

Governor Rod Blagojevich of Illinois, a Democrat, has asked the Food and Drug Administration for permission to buy 30,000 doses of flu vaccine from overseas drug wholesalers. The state has been promised only 35,000 flu shots for nursing homes in the state, which have some 100,000 residents.

Ontario’s Health Minister, George Smitherman, reassured Ontario residents October 27 that the Canadian province would not run out of free flu shots despite the large numbers of Americans now lining up at clinics in Ontario, particularly in the Niagara region. The clinics have been “inundated with long lines of Americans seeking flu shots, and there have been similar scenes in border communities across the country” (Canada.com News).

In the Pacific Northwest, a special “flu ferry” was organized between Seattle and Victoria, British Columbia. After the Victoria Clipper announced its flu-shot special, callers jammed the ferry company’s telephone lines. At one private clinic in Surrey, British Columbia, a few miles from the Washington border, between 300 and 350 US citizens have been coming every day.

Horror stories abound. USA Today reported the case of a 54-year-old AIDS patient in San Francisco, Martin Jones, whose compromised immune system makes him particularly vulnerable. Jones has been unable to receive his normal flu vaccination because a local nursing care provider, Continuum, received no doses. Continuum’s executive director told the newspaper, “So we have nothing for people like Martin. For our patients, the flu could be fatal. I find it amazing that the administration talks about fighting terrorism, and yet it can’t adequately fight a viral terrorist we’ve known all about.”

In Colorado, the prison system has not received any flu vaccine, leaving 19,400 inmates and 5,000 staff unprotected.

Several private companies with stocks of flu vaccine have allegedly engaged in price gouging, seeking to make a windfall profit out of the public’s misfortune. In Texas, the attorney general has filed a lawsuit against two vaccine distributors, claiming that they overcharged Texas hospitals by demanding $900 per 10-dose vial, instead of the normal $80. Dallas’ Methodist Charlton Medical Center, a charity institution serving critically ill patients, unable to pay the inflated prices, was left with no doses.

The State of Connecticut is suing a Fort Lauderdale, Florida, drug wholesaler for allegedly charging exorbitant prices for the vaccine. According to hospitals in Torrington and Bridgeport, Meds-Stat was also attempting to charge $900 a vial. Kansas and Florida have already filed suit against the company.

On line in New York City

The population of New York City, crammed into close quarters in housing and transportation and at work, is particularly at risk. The city is asking the Bush administration for 600,000 flu shots to inoculate elderly people and the chronically ill. According to New York Newsday, “The flu season won’t peak until January, but thousands of panicked New Yorkers, many of them elderly, have been flooding hotlines and waiting in long lines for a chance at the scant vaccine.”

On October 26, in response to the lines, city health authorities allowed people to take numbers and wait in parked buses. According to officials, some 17,000 people have received flu shots at city clinics and senior centers.

A World Socialist Web Site reporter spoke to some of those waiting outside the Chelsea Health Center on 9th Avenue in Manhattan on October 25. A 72-year-old woman commented, “This whole situation is very lousy. It has been very trying for me. I came here from another center. They only had 100 shots. I had number 104, so I was out of luck. At the other center, there were a lot of seniors, about two full rooms of them, plus some that were on the street. Hopefully, I will get a vaccine here, but I don’t know that I will. They say that they only have 300 shots, and my number is 370.

“I am very disappointed with the government. Do they want all the seniors to die so that they don’t have to pay social security?”

Michael Peterson told the WSWS: “I am only 56, but I have asthma and other respiratory problems. I get sick a lot during the flu season. I get pneumonia a lot. In the past, the vaccinations have worked for me very well. I still get sick in the winter, but not nearly as bad as without the flu shots.

“I blame this on the Bush administration relying on only one outside source. This is unconscionable and irresponsible.”

John, a retired engineer, 72, said, “I have been here four times at different times just to see if I could get a vaccine. They always tell me that they ran out of shots, except for the first time. The first time, I was lucky enough to be able to get the vaccine. It was the last shot of the day, but I gave my shot up to a lady behind me. Even though she was under 65, she was asthmatic and diabetic, and she had to go back to work.

“I think that it is terrible that we need to rely on foreign supplies. This country has the wealth and the power to produce everything. The US companies decided not to [produce the vaccine] because there is no money in it.”

Vaccine crisis and profits

Predictably, the Bush administration is attempting to lie and bluster its way through the crisis. In the face of polls showing that more than four in ten Americans say that they or someone in their family is at high risk from the flu and that two thirds of the population are concerned about the shortage, administration officials continue to downplay the crisis.

As Gardiner Harris noted in the New York Times, normally “officials liberally throw around words like ‘serious’ and ‘alarming’ to try to get the attention of the millions of people who fail to see how stupid they are to skip getting shots. This year, however, top health officials are insisting that the flu is well in hand, that there is no crisis.”

US Surgeon General Richard Carmona, a Bush appointee, embarked on a national tour just days before the general election, seeking to reassure the public. The Atlanta Journal-Constitution reported that it had obtained documents from employees at the CDC detailing the tour’s path through such “swing states” as Florida, Minnesota, Ohio, Pennsylvania and Wisconsin. Carmona rejected the suggestion that the tour might have a political angle. “For me it’s not political,” he said, convincing no one, adding that while he “can’t guarantee” everyone who needs a flu shot will get one, he is working “diligently to get [the vaccine] to those at risk.”

As a second line of defense, contradicting their own assertion that there is no problem, administration officials blame the shortage on trial lawyers and lawsuits involving vaccine manufacturers. In support of the Bush government claims, the pro-big business Club for Growth took out a full-page advertisement in the October 27 New York Times claiming that flu vaccine manufacturers have been crippled by hundreds of lawsuits.

Numerous commentators have pointed out the falsity of this claim. Public Citizen, the consumer advocacy group, countered in a press release that only a handful of suits have been litigated over the flu vaccine in the past 24 years. The Club for Growth ad cited a $30 billion lawsuit, neglecting to mention that the case had nothing to do with the flu vaccine; it concerns the use of the preservative thimoseral in childhood vaccines.

In fact, the flu vaccine shortage is the direct product of a health care system entirely at the mercy of the drive for corporate profits. Global flu vaccine sales are worth less than $1.8 billion a year, “a figure that doesn’t even crack the top 20 sales ranking for an individual drug sold in the United States,” according to Bruce Japsen in the Chicago Tribune. For example, the cholesterol drug Lipitor alone will generate $10 billion in worldwide sales for drug giant Pfizer this year.

Japsen continues: “Since Wall Street increasingly demands drug companies churn out blockbuster drugs that generate at least $1 billion in annual sales, the world’s largest drug makers avoid the vaccine business altogether. ‘No pharmaceutical company worth its salt will pursue a market unless it is worth at least $1 billion in sales,’ said Ben Andrew, health-care industry analyst at Chicago investment bank William Blair & Co. ‘Flu vaccines are just too small of a market,’ Andrew said. ‘It’s practically charity work.’ ”