D?j? vu all over again—again


Once more, the United States doesn't have enough of a vaccine—this time, flu vaccine. Just as the influenza season was about to start, the bad news hit the headlines: The entire output of the California-based Chiron company's influenza vaccine has been condemned by the authorities in the United Kingdom, where Chiron's vaccine, Fluvinir, is manufactured. US authorities had counted on 100 million doses of flu vaccine this year—up from 87 million available last year. About half that amount was to be supplied by Chiron.

By mid-October, the Centers for Disease Control and Prevention and Aventis Pasteur had announced the first phase of a collaborative plan to allocate and distribute to areas of need 22.4 million doses of vaccine that had not already been shipped. Priority groups identified by both the CDC and the AAP are listed in the accompanying table. Children and adults outside these priority categories will have to go without. Distribution will begin with hospitals, long-term care facilities, nursing homes, and private providers who care for young children. Says CDC Director Julie Gerberding, MD: "This plan will help ensure that vaccine gets to those people who need it most."

Fundamental flaws in the way vaccines are produced and distributed in the US-including too few manufacturers and an outmoded egg-based means of production-have been identified repeatedly but not addressed. Will the latest crisis goad Congress into mandating thoroughgoing reforms? At a news briefing, Health and Human Services officials said they are discussing incentives to lure manufacturers to the market.

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