Vaccine Prebooking for 2006-07 Flu Season Gets Under Way

Family physicians should be prepared to order influenza vaccine for the 2006-07 flu season even earlier than they did last year, according to the AAFP Task Force on Influenza Vaccine. That news came out of a meeting last month with representatives from the three manufacturers of trivalent inactivated vaccine for the 2005-06 flu season. All three manufacturers of the current season's flu vaccine -- Chiron Corp., GlaxoSmithKline and sanofi pasteur -- anticipate offering flu vaccine during the 2006-07 season.

Last month, sanofi pasteur -- the only manufacturer that sells TIV directly to physicians -- sent letters to those who had ordered from the company within the past 20 months or who were placed on a waiting list for vaccine last year, notifying them that flu vaccine prebooking would begin promptly at noon EST on Jan. 31. In response to that announcement and to subsequent decisions by some vaccine distributors to begin taking vaccine orders, the AAFP launched a new Web-based resource, the Influenza Vaccine Information 2006-2007 page.

AAFP members can link to the sanofi pasteur vaccine ordering site -- VaccineShoppe.com -- from the AAFP page and access contact information for vaccine distributors working with Chiron and GlaxoSmithKline. Some of those distributors have already begun prebooking vaccine. The AAFP page also links visitors to other information related to vaccine administration, such as AAFP/CDC immunization recommendations and current payment rates. The page will be updated on an ongoing basis as new ordering information and other tools become available.

Physicians who plan to order from sanofi pasteur should note: In addition to using the Web site, physicians may order by phone at (800) VACCINE [822-2463], but no faxed orders will be accepted. Physicians who haven't ordered from sanofi pasteur before must create an account with the manufacturer before Jan. 31 to successfully order vaccine on that date -- a process that can take several days.

Members of the AAFP task force formed last November met with representatives from the vaccine manufacturers Dec. 17 in Kansas City, Mo. A representative from vaccine distributor McKesson Medical-Surgical Solutions, which has handled flu vaccine from all three manufacturers this season, also participated in the meeting.

A chief focus of the gathering was to share information about the purchase and distribution problems that have plagued the 2005-06 flu season. Results of an AAFP survey e-mailed to members Nov. 14 indicated that more than one-half of respondents received 40 percent or less of the vaccine they ordered for this season. About one in five respondents reported receiving no vaccine at the time of the survey, while about one in five had received all of their vaccine.

Many factors appear to have contributed to difficulties family physicians had last year obtaining vaccine in time to start immunizing their high-risk patients when those patients began seeking vaccinations. Those problems ranged from discoveries by some FPs that vaccine they thought had been successfully prebooked had not, in fact, been ordered to significant setbacks experienced by one manufacturer.

Capt. Raymond Strikas, M.D., of the U.S. Public Health Service and associate director for adult immunization with the National Immunization Program, represented the CDC at the task force meeting. In this context, he told meeting participants, the CDC's function is primarily to educate the public about the advisability of seeking immunization and to support health professionals in their efforts to vaccinate patients -- not necessarily to "fix" problems with the annual flu vaccine distribution system.

"We have an advocacy role, a modest role," Strikas said. "Except in the event of an emergency -- such as what we saw last year (the 2004-05 flu season) -- or when the Vaccines for Children program is involved, this is more of a market issue."

The CDC fielded its own survey to physicians on this issue, he noted, as well as public surveys on ease of access to vaccine. Physicians who placed orders of between 500 and 1,500 doses seemed to have the most difficulty acquiring vaccine in a timely manner, Strikas said.

Litjen Tan, Ph.D., director of infectious disease, immunology and molecular medicine for the AMA, offered updates on activities of the National Influenza Vaccine Summit, which is co-convened by the CDC and AMA. He informed task force members about an idea floated to various vaccine supply and distribution stakeholders that a special pre-ordering period be established for physicians in small office-based practices. The proposal has been favorably received in many sectors, Tan reported, although much work remains to be done to bring such a plan to fruition.

As stated in a letter AAFP President Larry Fields, M.D., of Ashland, Ky., sent earlier this month to AAFP members, "Prospective vaccine buyers can maximize their chances of getting the vaccine they need by splitting their total order among various vaccine sources. That doesn't mean physicians should book more vaccine than they expect to use; it simply means purchasers can spread their risk by booking vaccine from more than one manufacturer/distributor."

Other ordering tips:

Despite the healthy exchange of information that took place at the December meeting, significant uncertainties about the current system for obtaining vaccine remain and need to be addressed, according to AAFP President-Elect Rick Kellerman, M.D., of Wichita, Kan.

"The influenza vaccine distribution system is a Gordian Knot that needs to be unraveled for the health of our patients and our country," Kellerman said. The fact that influenza vaccine is a biologic agent and is administered seasonally only complicates the issue. Physician offices, long-term care facilities and hospitals must be at the front of the line to receive influenza vaccine if we are to vaccinate high-risk patients."

Task force members met again Jan. 22-23 to finalize their report and recommendations, which are scheduled to go to the AAFP Board of Directors in time for the Board's March meeting.