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As headlines nationwide trumpeted news of a critical shortage of flu vaccine, AAFP members at the Assembly debated a resolution calling for the Academy to work with federal health policy-makers to find better ways to respond to vaccine shortages.
According to testimony in an Oct. 11 reference committee hearing and on the floor of the Congress of Delegates the next day, current flu vaccine prioritization recommendations leave little for physicians' clinical judgment. Moreover, physicians exercising that judgment have no liability protection when forced to make tough decisions about who should receive the scarce vaccine.
The upshot: The Congress approved a late resolution from the Rhode Island AFP directing the AAFP to "work with the CDC to create alternative recommendations and risk stratifications to be used in states and localities where there is a shortage of vaccine." Delegates also called on the Academy to work with federal legislators to create "a short-term liability shield" for physicians employing such alternative recommendations.
The AAFP, through its liaison to the CDC's Advisory Committee on Immunization Practices, worked feverishly in early October to create prioritization recommendations following word that British regulators had temporarily shut down flu vaccine manufacturer Chiron's Liverpool, England, plant. Chiron, one of only two manufacturers of flu vaccine for the United States, had been scheduled to produce about 48 million doses for the 2004 – 2005 flu season.
But, as Herbert Young, M.D., director of the AAFP Scientific Activities Division, pointed out in an interview, "the ‘A' stands for ‘Advisory,'" and the committee can only go so far in promoting community-based physicians' interests -- the CDC makes the final call.
Add to that the CDC's decision in mid-October to have the second vaccine manufacturer, Aventis Pasteur, divert shipment of some 22.4 million doses to areas identified as serving high-risk patients and those deemed to have the most severe shortages -- and many FPs find themselves with no vaccine to offer patients.
Debate on the vaccine issue was heated in the reference committee hearing. Doug Campos-Outcalt, M.D., of Phoenix, a member of the AAFP Commission on Clinical Policies and Research, decried a system that leaves so much responsibility for the health of the American public in the hands of overseas manufacturers.
"How we've let our situation come to this -- how we've allowed ourselves to become so dependent on this foreign manufacturer -- is hard to believe," said Campos-Outcalt. "What this issue has brought to light is the entire larger issue of flu prevention."
An anecdote Wisconsin alternate delegate Susan Kinast-Porter, M.D., of Monroe relayed in the Congress aptly summarized the issue. "We're supposed to use the CDC-AAFP stratification, which wants to treat everybody over 65 the same," she said. "We don't have enough (flu vaccine) for our whole country, with all the people who qualify.
"I wanted to put a patient with COPD who's on oxygen and prednisone and living in a nursing home ahead of healthy 66-, 67- or 70-year-olds who are out playing golf and living alone in their own homes. I was told (by local health officials) I couldn't withhold any vaccine from the healthy 66-year-old to give to the 66-year-old with COPD, O2 and prednisone if the healthy person came to me first."
Academy, CDC post flu vaccine infoA number of resources are online to guide physicians through the vaccine shortage:
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The Congress also acted on other public health measures. Among them:
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
FP Report is
published by the AAFP News Department.
Copyright © 2004 by American Academy of Family Physicians.