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| ASSEMBLY EDITION • ORLANDO, FLA |
Even as headlines nationwide trumpeted news of a critical shortage of this year's flu vaccine, AAFP members this week 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 Monday's reference committee hearing and on the floor of the Congress of Delegates Tuesday, 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 last week 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 on Wednesday, "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 this week 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 hot and heavy in Monday's 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."
 Andrew Eisenberg, M.D., testifies before a reference committee about the broad spectrum of environmental impact on patients' health. |
Andrew Eisenberg, M.D., of Madisonville, Texas, a member of the AAFP Committee on Chapter Affairs, pointed to other vaccine-related problems. "The key issue we need to promulgate is vaccination of health care workers," he said.
An anecdote Wisconsin alternate delegate Susan Kinast-Porter, M.D., of Monroe relayed Tuesday 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 county, 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."
The Congress also acted on other public health measures. Among them:
• Delegates adopted a resolution calling for the AAFP to inform members about the risks of secondhand tobacco smoke, to encourage FPs to counsel patients about those risks and to work with government at all levels to promote smoke-free public environments. They also called for the Academy to reaffirm its opposition to all forms of tobacco advertising, especially those targeting children.
• The delegates adopted new Academy policy promoting healthy eating in schools, while referring two related measures - concerning the availability of soft drinks and other sweetened drinks in schools - to the Board of Directors.
• In that same vein, delegates also approved a recommendation from President Michael Fleming, M.D., to broaden AAFP's fitness initiative, Americans in Motion, through traditional and nontraditional partnerships, including exploring the creation of a school-based diet and fitness program modeled after the Tar Wars® program.
• Delegates called for the AAFP to increase its efforts to educate members about substance abuse issues, including considering this issue as a topic for a future Annual Clinical Focus. They also directed the Academy to consider partnering with other organizations to address the problem of substance abuse.
• Delegates directed the AAFP to revise its existing policy on environmental pollution to include a position favoring reduction of ozone levels to combat global warming.
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