October 2002 • Volume 8 • Number 10 |
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It's a delicate balance: Producing enough influenza vaccine to meet demand. Even more critical is having the vaccine in physicians' hands when the demand is there -- in October.
Fortunately for FPs, that is not a problem this year. Vaccine manufacturers report they began shipping as scheduled in September, and the CDC is forecasting that more doses than ever -- 92 million to 97 million -- will be produced. But other issues, such as prioritization, cost and reimbursement, are still a concern.
Extending target groups
This year the CDC moved to "encourage" that children 6 to 23 months old be vaccinated when feasible because of statistics showing increased risk for influenza-related hospitalization in this group. The action fell short of a formal recommendation, however. The AAFP has also moved to encourage that this population be vaccinated, as well as household contacts and caretakers for infants up to 23 months when feasible.
The CDC's categorization of "high risk" was first extended in 2000 to persons 50 and older. But health care professionals then were hard-pressed to meet the new demand in a year marked by critical shortages and delays for the vaccine. Officials this flu season will likely study the impact of widening the risk category to include youngsters.
As in years past, the CDC and AAFP want vaccination efforts in October to focus on priority groups. That said, "providers should not turn away other individuals seeking influenza vaccination," says the CDC Web site at http://www.cdc.gov/nip/flu/Bulletins_2002-03/bulletin_3.htm.
Many physicians have expressed anger at seeing chain stores hold mass immunization drives in October -- especially when physicians' offices hadn't yet received their vaccine shipments.
The AAFP has taken notice, says Herbert Young, M.D., director of the Scientific Activities Division. "The Academy has worked with manufacturers, the CDC, AMA and others to assure that family physicians can obtain sufficient influenza vaccine."
Healthy working adults
A cost-benefit analysis published in the Aug. 20 Annals of Internal Medicine indicates flu vaccine is beneficial to healthy working adults, yet some health officials say the vaccine is underutilized.
At least one vaccine distributor would like to see more healthy adults getting the vaccine.
"We were happy to see that (study published in Annals)," says John Trizzino, vice president of business development for the medical group of distributor Henry Schein. "We really need to promote people coming out to get their vaccine this year instead of concerning them about shortages."
According to the Annals study, an average worker with the flu misses 2.8 working days, reflecting lost wages of $397.88.
So why not recommend universal vaccination? The CDC is reluctant to extend the recommendation to healthy persons, says CDC flu expert Carolyn Bridges, M.D. Consider the math: There are 280 million Americans -- about three persons for every anticipated dose of flu vaccine, she notes.
The CDC is more concerned with the mortality rate in high-risk groups. About 20,000 deaths each year are attributed to flu. Look at this statistic in light of reports of 10 million unused doses of vaccine at the end of last flu season, and it's easy to appreciate the disconnect between policy and practice.
Supply side
Two flu vaccine manufacturers -- Aventis Pasteur and Wyeth Vaccines -- are now accepting new orders on their waiting lists, having pre-booked all vaccine for the 2002 03 flu season. At press time, Wyeth was projecting a price increase competitive with other manufacturers. Aventis was charging $6.50 per dose based on purchase of a 10-dose vial -- its highest price; incentives are available for repeat customers and large orders. Distributor Henry Schein has the Evans Vaccines brand of influenza vaccine available but, as of press time, had not published its list prices.
Reimbursement still low
The news isn't good when it comes to reimbursement for vaccinating patients. The Medicare reimbursement, effective Oct. 1, is $8.02 for the flu vaccine and $3.98 for the administration fee, for a total of $12 per injection -- only a 2.48 percent increase over 2001, says Kent Moore, AAFP manager of health care finance and delivery systems. In 2001, Medicare reimbursed $4.59 for administration plus $7.12 for the vaccine, for a total of $11.71.
"We are still fighting to get the reimbursement needed by our members for this important clinical preventive service," says Young.
To read more about the vaccine supply, including ordering information, go to http://www.cdc.gov/nip/flu/Bulletins_2002-03/bulletin_3.htm. To read AAFP's recommendations on administering flu vaccine and an explanation of high-risk groups, go to http://www.aafp.org/x10638.xml.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.