U.S. Secretary of Health and Human Services Tommy Thompson this week declared that the sudden shortage of influenza vaccine in the United States is "not a health crisis." He argued that anxious Americans should be patient while the government works to reallocate the nation's limited supply of vaccines.
To his credit, Thompson was trying to prevent panic -- and prevent the long lines of flu-shot seekers we are increasingly seeing on the nightly news.
But let's call a spade a spade. The Merriam-Webster OnLine dictionary defines "crisis" as "an emotionally significant event or radical change of status...especially one with the distinct possibility of a highly undesirable outcome." A review of the statistics makes it clear that even if the 36,000 flu-related deaths we are accustomed to annually is not a crisis, this year's situation is.
First, Centers for Disease Control numbers indicate that 98.2 million Americans are considered to be a high risk for influenza and its complications this year -- and thus are on the CDC "target" list for getting the immunization.
This group consists of people 65 or older (35.6 million), those age 2-64 with chronic illness (39.4), pregnant women (4.0), children 6-23 months (5.9), health care workers under 65 (7.0), and household contacts of those under age 6 months (6.3). A second tier of "target" population includes a broader group of those who have household contact with high-risk persons age 2-64. Combining these two risk tiers, we get a total target populatiion of 187 million people at higher than average risk of flu.
Even sticking with just the top priority risk group -- 98 million who need shots -- our current supply (about 50 million) is by no means adequate.
Second, it has become obvious that we will have to further prioritize who is at the highest risk among those in the overall high risk group, now that half of our supply of flu vaccines are contaminated and thus unavailable. Given that over 90% of the 36,000 flu deaths last year occurred in the elderly, those over 65 are now considered first in line to get a shot. Last year, only about 66% of that age group were vaccinated. If that percentage now increases significantly due to the prevailing anxiety, which may prompt older people who do not regularly get the flu shot to seek one this year, perhaps as many as 90%, about 32 million, of our 50 million supply should be used by the elderly.
This would leave us approximately 18 million doses for 66 million other top-tier high-risk Americans, including those with chronic heart, lung, and other diseases, HIV infection and other debilitating conditions, pregnant women, young children, and health care workers. The bottom line is that there will inevitably be about 50 million high-risk Americans who will be denied immunization. With all the publicity about the shortage, it appears that we do indeed have on our hands "an emotionally significant event or radical change in status -- especially one with the distinct possibility of a highly undesirable outcome." It's a crisis.
But just because it is a crisis doesn't mean we need to panic. We just need a reasoned game plan.
What are we to tell those 50 million high-risk people who are worried sick because they or their loved ones cannot be protected from flu this year? What do we tell the parent of a 16 month-old child (or a pregnant woman, asthmatic, physician, or nurse) who can't be vaccinated because there is no vaccine left? If on one hand we say "don't worry, everything will be fine, your health is not in jeopardy," we will understandably be accused of doublespeak. How can we tell high-risk people one day they need a flu shot to protect their life and health and then tell them the next, "It's OK, you'll be fine," when the only thing that changed is the availability of vaccine? If we tell these high-risk individuals that they need not fret about not getting their flu shot this year because serious illness and complications are not likely, how do we credibly tell them to get immunized to "protect their health" next year?
Physicians and public health professionals have to walk a very narrow line. We need to avoid panic at any cost while also telling the truth.
Here is what we should advise Americans under age 65 who have been told they are at risk but cannot get a flu shot:
#1. More than 90% of the serious complications of influenza occur in people over 65. You are not in that age category, and while you (or your child) may be at higher risk than most for complications, the risks are relatively small. If you did have a flu shot, your risks would be even lower, but the overwhelming odds are that if you do get the flu, there will not be major negative consequences.
#2. If you are in the non-elderly high-risk populations you should know that last year, rates of vaccination were relatively low among people with chronic illness (28%), pregnant women (12%), babies (30%), and health care personnel (38%) -- yet over 90% of deaths and hospitalizations from flu complications occurred in the over-65 age group, not these other groups (in whom we did not see substantial numbers of deaths or serious illnesses).
#3. There are some things you can do to protect yourself: wash your hands frequently, stay away from people who are coughing and sneezing, avoid crowded areas as much as possible. If you do get the flu, see your physician to see if any of the FDA-approved anti-viral drugs are appropriate for you. And beware of quacks seeking to profit from your fear.
#4. Yes, there will likely be an increase, perhaps a significant one, in the number of cases of flu this year, given that 50 million Americans who would otherwise have been immunized will not be. (Another way to look at it is that 35 million fewer people will be be vaccinated this year than last year, and thus are more vulnerable to the flu.) Your chances of getting the flu and/or getting a more severe case are now increased because you have not been immunized. Having the flu is debilitating and will inevitably lead to increased loss of productivity. The flu can make you miserable for a few days or a couple of weeks. But the overwhelming majority of people who get flu recover from it quickly.
#5 Although it may be of little immediate comfort to you -- the "worried, unvaccinated well" -- there may be an ironic silver lining to this year's flu crisis: if more older Americans get vaccinated, the overall death rate from influenza could be lower this year than it was in recent years -- since those in the most at-risk age category will have been protected. That is, sickness in the overall population may be greater, while those most prone to die from the flu are more likely to receive vaccinations than in a normal year.
