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May 11, 2005


Talking about problems with vaccines, check out this info from "Health Affairs"! Folks, if there ever was a "time capsule" type of effect explaining how miserably our so called health care system is designed and performs, this
has got to be it! If you fail in this part of healthcare, what exactly IS THAT (current non_existent) MISSION STATEMENT FOR OUR VERSION OF THE HEALTHCARE SYSTEM?

Press Release
Embargoed for release
Tuesday, May 10, 2005
12:01 a.m. EDT

Kari Root or Jessie Pinkrah
Jon Gardner at Health Affairs,

New Health Affairs Issue Assesses Vaccine Shortages; Calls
Pediatric Vaccine Supply Precarious

Millions of Privately Insured Children and Adults Do Not Have
Coverage for Recommended Vaccines

Bethesda, MD – Despite broad public support for insurance coverage
of vaccines, an estimated 15 percent of children and 30 percent of adults in
the United States who have health insurance are not covered for vaccines,
according to a new study published today in the May/June issue of the
journal Health Affairs. In addition, the nation’s pediatric vaccine supply
is considered “precarious,” given increasingly frequent shortages in several
pediatric vaccines, according to another study published in the May/June

The issue assesses the status of vaccines worldwide, examines
implications of the 2004 flu vaccine shortage, and details vaccine coverage
and supply issues. A survey, conducted by Catherine DesRoches and Bob
Blendon of the Harvard School of Public Health, and John Benson of the
Harvard Opinion Research Program, assesses how concerned the American public
was about the 2004 flu vaccine shortage and whether they truly understood
the potential flu threat.

The survey of more than 1,000 Americans found that more than half
significantly underestimated the seriousness of the flu. This may have been
an important factor in explaining why so many Americans did not seek flu
shots. According to the survey, just 10 percent correctly estimated that the
flu is responsible for 20,000 to 40,000 deaths per year.

More than half (56 percent) of Americans believe that doctors and
nurses should decide which of their patients should receive influenza
vaccines in times of shortage — not the federal government. Only 14 percent
of those surveyed expressed high levels of confidence in the ability of
government agencies, together with the vaccine industry, to ensure fair
distribution of flu vaccines. At the same time, most respondents said that
when vaccine supplies are scarce, they should be reserved for those at
greatest risk.

“Vaccines save lives. Clearly, the nation needs to find a way to
ensure the safety and supply of vaccines for Americans in need,” said John
K. Iglehart, founding editor of Health Affairs. “The American public places
a high value on vaccines, for children and adults alike.”

Immunization programs have been under intense scrutiny in recent
months: The United States experienced a severe shortage of influenza vaccine
last fall when its primary manufacturer was shut down; unsubstantiated
stories about a vaccine-autism link have fueled parental anxieties; the
federal stockpile of pediatric vaccines, intended to forestall shortages,
has been depleted; and fears of new infectious diseases, like avian flu,
have called into question the lengthy vaccine development process. The
May/June issue of Health Affairs examines these and other challenges to
immunization programs around the world.

Vaccine Underinsurance

One study finds that even people with insurance may not be covered
for immunizations, attributing partly to low U.S. immunization rates. As
many as 5 million privately insured children and 36 million privately
insured adults are not covered for immunizations — a factor that may be
contributing to low U.S. immunization rates, according to study authors
Matthew Davis and Kathryn Fant of the University of Michigan in Ann Arbor.

Although more than half of states require coverage of recommended
vaccines for children, none requires comparable adult coverage (principally
for influenza and pneumococcal vaccines), according to the study.

“Over the past few years, newly approved vaccines have been
increasingly expensive, so insurance plans have been less likely to cover
them,” said lead study author Davis. “This means that new vaccines of the
future may be available to many people only if they can pay out of pocket.”

According to the authors, this is the first study to show broad
public support for coverage of all recommended childhood and adult vaccines
by employer-sponsored coverage. A majority of the 995 respondents surveyed
said that they would be willing to pay higher premiums for vaccine coverage.
In fact, 78 percent of people with children at home said that they would be
willing to pay an additional $3 to $6 per month for vaccine coverage. By and
large, they also strongly believed that vaccines are effective and generally

Public Views on the Flu Vaccine Shortage

Faced with a serious shortage of influenza vaccine in fall 2004,
the Centers for Disease Control and Prevention (CDC) recommended that these
immunizations be provided only to specific high-risk groups. DesRoches,
Blendon, and colleagues surveyed 1,277 U.S. adults late last fall to find
out what they knew about the shortage and potential remedies. They found

a.. Two-thirds of Americans believed that their community was
experiencing a shortage, and 60 percent were concerned about it
b.. Nearly 40 percent blamed “vaccine manufacturers and
pharmaceutical companies” for the shortfall, and nearly 30 percent blamed
“federal government public health agencies”
c.. 45 percent believed that it should be up to the federal
government to ensure an adequate vaccine supply, and 26 percent thought
manufacturers should do so.
Although Americans generally supported reserving influenza vaccine
for people at greatest risk, the majority believed that individual doctors
and nurses should decide who receives it, not the CDC (56 percent versus 16

Following the 2004 shortage, many people referred to the handling
of the shortage as a successful experiment in health care rationing. But the
study authors point out that many people did not seek the flu vaccine, for a
variety of reasons: They felt that the threat was not serious, they
perceived that they couldn’t get the vaccine, or they had safety concerns.
The authors warn that if the country faced an outbreak of a lethal, highly
contagious disease, it might be “much more difficult for physicians and
public health officials to ration a limited [vaccine] supply based on
categories of health risk.”

They also warn that the government may have a difficult time
convincing the general public to get vaccinated this year because many will
doubt that there is an ample supply.

Precarious Vaccine Supply

The U.S. supply of pediatric vaccine is “precarious” according to
study authors Patricia Danzon, University of Pennsylvania, and Nuno Sousa
Pereira, Universidade do Porto, Portugal, who cite a declining number of
producers and products. “Five firms produce almost all routine childhood
vaccines, and five of the eight currently recommended pediatric vaccines
have a single supplier,” they write.

According to the authors, the problem isn’t likely to resolve any
time soon. Vaccine manufacturing involves large research and development
costs and high fixed investments in facilities and processes that must be
maintained over a long period. In addition, the product is usually good for
only one flu season; demand is unpredictable (less than half the people for
whom the vaccine is recommended receive it); and competition keeps prices

Health Affairs, published by Project HOPE, is the leading journal
of health policy. Copies of the May/June 2005 issue will be provided free to
interested members of the press. Address inquiries to Jon Gardner at Health
Affairs , 301-347-3930, or via e-mail, [email protected]. Selected
articles from the May/June 2005 issue are available free on the journal’s
Web site, www.healthaffairs.org.


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©2005 Project HOPE–The People-to-People Health Foundation, Inc.

Health Affairs - 7500 Old Georgetown Road, Suite 600 - Bethesda,
MD 20814

Truly amazing that more than 50 years after the first polio vaccine we haven't been able to put this disease on the extinct list. I remember when I first visited Nicaragua in 1980 that one of the good things the Sandinistas were doing was setting out to vaccinate every single person in the country against polio, starting with the kids. They would have succeeded had it not been for the contra war.

Thanks, NG!

MB, when Plutonium page told me about one of these articles, I commented that the first thing you think of is war. War disrupts public health.
You gave a Sandanista example, but 9/11 skewing public health in the US towards bioterror and away from infectious diseases is another.

The new Polio outbreaks have a great deal to do with Religion.

This apparently began several years ago in Indai with a "Rumor" that the vaccine would make female children sterle. India quickly solved the problem by re-training Muslim Nurses to conduct the door to door campaign, and then convinced local preachers to speak against the rumor at Friday Prayers. Within a few months, the epidemic was stopped.

However the rumor traveled to Nigeria, and became all tangled up with the conflict between the the Muslim North and the Christian South and in the meantime the Polio virus spread in the Muslim areas, and the process of convincing the Mullahas who in the meantime had adopted the rumor as truth, was delayed. The virus in the meantime spread beyond Nigerian borders.

The WHO epidemologists have traced the current spread in Yeman and Indonesia to small groups that attended the Haij this year -- villages where it has shown up all had small groups that traveled in groups to Saudi Arabia and lived in the same camps with Nigerian pilgrims from areas where Polio is active, and where many are still not viccinated.

Sadly, WHO had asked the Saudi's to exclued Nigerians from affected areas this year, but they ignored the advice.

Lots of things are the fault of US Policy -- but this is a pretty clear case of what happens when religiously based shortsightedness trumps Science -- and the shame is that the Science Types did not speak out clearly and prophetically and loudly when it might have helped.

All good points, Sara.

Not everything is Bush's fault, mind you, but there is obviously not the single-minded resolve on polio that there is on, e.g., John Bolton. Nor is war the only issue as you have pointed out.

I think that absent a war on terra/war against Muslims (as, alas, some parts of the world see this), we'd be in a stronger position to eradicate a scourge.

I think Smallpox very dangerous disease we need to struggle for eradication of theses kind of disease for all over the world.

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