Reviews Press

US media needled over flu vaccine shortage

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:1050
  1. Daniel Engber, freelance journalist (engber{at}
  1. Washington DC, United States

    An outbreak of feverish media coverage has been unleashed upon the United States. “We're facing the prospect of a major epidemic,” says Dr Arthur Kellermann, of the American College of Emergency Physicians, who has been interviewed about the shortage of flu vaccine for no fewer than 14 television and print stories over the past few weeks.

    Fifty million doses of flu vaccine, or around half of America's expected supply, were condemned on 5 October when British regulators found bacterial contamination at the Liverpool factory where they had been produced. Newspaper articles were quick to deliver the relevant statistics: only 60 million doses would be available in the United States, for the 90 million Americans deemed to be at “high risk” from the influenza virus.

    “Scene by disheartening scene, the spectacle of a severe shortage of flu vaccine is unfolding around the country,” wrote Denise Grady in the New York Times. Two days later, the ubiquitous Dr Kellermann appeared on a PBS broadcast to point out that “without swift action, the vaccine shortage could cripple our healthcare system.”

    Although the papers touted the “flu crisis” of 2004, few cases of the flu were actually reported. An article published on 18 October noted “scattered cases in seven states,” but for the most part the news focused on what might happen once the flu season began in earnest. In years without vaccine shortages, as many as 36 000 Americans die from the flu, with 200 000 more hospitalised—and a diminished vaccine supply would put even more people at risk.

    Once the crisis had been established, coverage turned to its secondary effects. Several elderly people required hospitalisation after spending hours waiting for a flu shot, and a 79 year old woman in San Francisco collapsed in line and died. A number of towns throughout the country have set up lottery systems for distributing the vaccine to those most in need—“We are hoping the public sees this as the most fair and equitable way to do this,” one official told ABC News. And a set of proposed state laws would make it illegal for doctors to give vaccines to people not at risk for complications from the illness.

    A bit of a scandal transpired when the Chicago Tribune reported that the entire Chicago Bears football team had been offered flu shots, but team officials now claim that only two players actually received the vaccine—and both have asthmatic conditions that place them at especially high risk. Every member of the Chicago Bulls basketball team had also been vaccinated before the shortage was announced.

    While the federal Centers for Disease Control joined state legislatures in urging doctors to save flu shots for high risk patients, the Capitol's own attending physician, Dr John Eisold, urged all 535 members of Congress to get vaccinated, even if they were in good health. He argued that lawmakers—who shake a lot of hands, and often meet elderly and sick people—were at particular risk of getting infected and passing on the virus. News reports have identified at least eight members of Congress under the age of 65 and in good health who have received the vaccine, including House majority leader Tom DeLay.

    Embedded Image

    Cartoon from the Milwaukee Journal-Sentinel

    Both of the presidential candidates have promised to forego vaccination this year, but each has used the vaccine shortage in their media campaigns. In public speeches and radio advertisements, Senator John Kerry has accused the president of jeopardising the lives of children, pregnant women, and elderly people. Members of the Bush administration have responded by using press conferences to blame the shortage on the excessive costs of medical malpractice insurance, which they say has pushed manufacturers out of the vaccine business.

    The major newspapers have indulged in a great deal of introspection and sobering analysis of what went wrong. Warnings about the nation's vaccine supply have been pointed and frequent over the past few years, as the number of suppliers has diminished. America now receives almost all of its flu vaccine from two sources, while demand has quadrupled over the past decade. In contrast, the United Kingdom relies on five different suppliers.

    A certain amount of resentment towards the British has also emerged in response to this disparity. An editorial in the Chicago Sun-Times under the headline “Brits too quick to close flu vaccine factory” accuses the British regulators of having been “nitpicky because they could afford to be… The British will not be facing needless disease and death this winter—Americans will.”

    Some of the news stories have pointed out that in most years the United States ends up with too much of the flu vaccine, and millions of doses end up being destroyed. Vaccination rates tend to be well below the national goal of 90%, especially among minority groups and people over the age of 65. Until now, health officials have had to work hard to raise awareness and increase demand for the flu shots among these groups.

    “Most years at this time, we're begging people to come in,” said the US surgeon general Richard Carmona. He went on to call the situation “an artificial crisis,” caused by an increased demand resulting from all the publicity.

    Carmona's claim suggests one story that hasn't yet appeared in the popular press: could all this publicity improve vaccination rates in the coming years? More to the point: will the flu crisis of 2004 end up saving American lives?

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