U.S. flu vaccine shortage exposes crisis in health care

By Mark Ostapiak

Like summer or autumn, flu season in the United States is for many an inseparable period of the yearly cycle and for some, it marks a period in a lifetime like an infamous hurricane or drought. Reckoning how to stave off this virus, which last year resulted in 36,000 deaths and 200,000 hospitalizations, should not be taken lightly.

Recently, those counting on the routine vaccination, hopeful of dodging the virus’s debilitating symptoms, were caught off guard when the federal government announced that one of only two vaccine suppliers was forced to withhold distribution. When British regulators suspended California-based Chiron Corporation’s distribution license on Oct. 5, the U.S. lost nearly 50 million flu vaccine doses.

With Chiron out, French-owned Aventis Pasteur stood as the remaining major manufacturer doing business with the United States. Contracted to deliver 58 million doses, they have emerged as the virtual sole distributor. MedImmune, producer of nasal spray vaccine, has made an additional 3 million doses available for distribution.

The severity of the 2004 virus remains to be seen. But what’s certain is that this year’s images of endless lines of people waiting to be vaccinated will persist for some time. More importantly, though, are the lessons that can be drawn from this failure of the capitalist system of production to ensure basic health care.

Pointing fingers

Bill Pierce, a spokesman for Health and Human Services, told the Washington Post, “We’re resisting the temptation to blame anybody, and we hope others do, too.” Soon after the shortage made headlines, Kerry tried to score some political blows by blaming Bush. To save face, Bush said that he would forgo getting the shot.

However, at the advice of the Capitol’s attending physician, John F. Eisold, more than 2000 congressional members—even those not falling into the high risk category—lined up to be vaccinated free of charge. The justification given was that they often shake hands and are in regular contact with children and older people.

In schools throughout the country, with more children than Capitol Hill, the U.S. Department of Education has acknowledged that the vaccine shortage can have an acute affect. So they have suggested to “be creative about keeping their communities healthy, including posting information about hand washing in restrooms, providing flu messages in daily announcements, and being vigilant about cleaning and disinfecting classroom materials.”

Experts in economics, marketing, and medicine quickly added their solutions. Some suggested the need for protections from lawsuits and government subsidies for the pharmaceutical corporations. Others claim that what’s needed is to contract with more vaccine manufacturers. Meanwhile, replacing nearly 50-year-old production techniques with more advanced and efficient technology, which use mammalian cell cultures, has been a topic of minimum debate.

But Vice President Dick Cheney was blunt. “It’s a combination of the economics of the business,” he said in an AP dispatch. “They produced millions of doses, but if people don’t take it, they have to throw it out. The problem we have run into, producing vaccine is not a very profitable business.”

The vaccine market is highly variable, and largely dependent on consumers’ cost-benefit analysis of getting vaccinated. In the past, according to Wayne Pisano, executive vice president for commercial operations at Aventis, vaccine manufacturers for the U.S. market were likely to discard between 10 and 20 percent of their yearly production. Consequently, many vaccine companies cannot sustain their profits, and capitalist competition drives profits rates ever lower, which leads to plant closures.

“Healthy supplies”

The government, now on the defensive, sent their best shock troops to allay people’s concerns. The Oct. 21 Washington Post reported Health and Human Services head Tommy Thompson saying, “we’re prepared” and that the country had “healthy supplies” amounting to 61 million doses for an estimated 90 million at high risk for flu.

Perhaps overshadowing Thompson’s miscalculation were directives by U.S. Surgeon General Richard Carmona, which held that there are plenty of anti-viral medications—7 million doses stockpiled and 40 million already available. However, these anti-virals are not even flu vaccines.

Numerous examples make it abundantly clear that there is indeed a shortage, and some people are affected by it more than others. Time magazine pointed out that “a 50% cut in the vaccine supply does not affect all doctors, hospitals and clinics equally. To get a better price, many health groups contract with a single supplier for their vaccine. Indeed, some are required by law to do so. Most of those who were lucky enough to have ordered from Aventis had at least some vaccine on hand. But those who ordered exclusively from Chiron had none at all - and they include some of the country’s leading hospitals.”

Dr. Herbert Pardes, head of New York Presbyterian Hospital in Manhattan, told Time that they “were wholly dependent on Chiron.”

Claims have surfaced that theoretically there is enough vaccine to meet the demand. But that assertion fails to address the real problem of the inherent inefficiencies of the market system. Time points out that “the distribution system in the U.S. is so haphazard and complex, it seems unlikely that everyone in a high-risk group who wants a shot will get one this year.” Distribution is handled almost entirely by pharmaceutical companies.

While some state and local governments are struggling to meet the demand, others have decided to modify certain categories, resulting in the exclusion of significant sections of the population previously considered high-risk. Massachusetts arbitrarily raised the high-risk age from 65 to 75.

Additionally, diabetics aged 18-49 who are not dependent on insulin have also been denied priority status.

Symptoms of an ailing system

Between 2000 and 2001 the federal government’s General Accounting Office authored reports questioning both the U.S. preparedness in the case of flu pandemic and difficulties manufacturers were beginning to have for efficient distribution.

The Oct. 17 New York Times reported,“Indeed, on Sept. 28, exactly one week before Chiron’s license was suspended, the Government Accountability Office offered a prescient warning of potential disruptions in the flu vaccine supply.”

Though The Times did report that “between November 2000 and May 2003, there were shortages of 8 of the 11 vaccines for childhood diseases in the United States, including those for tetanus, diphtheria, whooping cough, measles, mumps and chicken pox,” little accounting has arisen for the seriousness of other vaccine shortages.

With $5.6 billion pledged to develop vaccines for anthrax, an abundant supply of doses should be available for a disease that exists only on the basis of government propaganda. For the sake of comparison, a mere $283 million is available for research to fight the flu.

Short of a fundamental solution, the ailing health-care system in the United States will remain entirely irrational and become even more inadequate. It’s a multifaceted crisis exacerbated by an inherent contradiction of U.S. capitalism, in which, on the one hand, health-care spending is a record $1.7 trillion (14.1% of the GDP), while on the other hand, nearly 47 million people remain uninsured.

The seriousness of this dilemma becomes more apparent in light of skyrocketing health-care costs, yearly rises in health-care premiums for workers, continued plant closures, the permanent loss of millions of high-paying manufacturing jobs, trillions in lost tax revenue resulting from corporate tax cuts, and the ultimate decline in real wages throughout the country. Working people in the United States must mobilize to win demands for a free universal health-care system fully funded by taxing the rich, and for a massive program of research, production, and clinics to fully immunize every one against communicable diseases. The resulting increased quality of life will point the way toward what a society can do when all basic human needs are guaranteed.

This above article first appeared in the November 2004 issue of Socialist Action newspaper.