by Claudia Kalb
The H1N1 vaccine shortage isn’t just frustrating. It’s unleashing an ethical and emotionally charged debate about people’s shot-worthiness. Back in August, the CDC announced recommendations on who should be first in line for vaccination. The list: pregnant women, caregivers for babies under 6 months, health-care workers, anybody 6 months to 25 years old, and people with health conditions like asthma and diabetes. But we all know that vaccine distribution hasn’t gone perfectly—lines have been long, supplies have run out, and, yes, some Americans have gotten the shot when they shouldn’t have.
All of this blew up into a vitriolic exchange on a local moms bulletin board in Washington, D.C., after a mother said she’d gotten vaccinated at a Virginia clinic even though she didn’t qualify. And she urged other moms to do the same to protect their kids. Hello swine-flu mommy wars. One woman called her selfish. (And there were choicer words, too.) Another warned there would be a “day of reckoning” for people like her. And this: “To the people who have gotten the H1N1 vaccine and are not in the CDC priority groups—WHAT YOU DID IS DISGUSTING. YOU ARE DISGUSTING.”
The calmer posts said she wasn’t at fault: at least some health-care workers at the clinic, they reported, were encouraging people to get the vaccine while they could—even if they weren’t in one of the priority groups. But that’s not supposed to happen, at least not until more ample supplies of vaccine are available. Moms aren’t the only ones at war. A report that Goldman Sachs and other big New York companies have received vaccine has some people up in arms, even though Goldman says it’ll provide it only to high-risk groups. And then there’s the news that Gitmo detainees will get vaccines, too. House Republican John Boehner isn’t too happy about that—and neither are a lot of other people.
Now, CDC Director Dr. Thomas Frieden is pulling out his megaphone and trying to bring some order. In a letter sent to state and local health officers and released by the CDC today, Frieden said, “It is more important than ever to focus on ensuring equitable access to the vaccine for the priority groups.” He went on to ask local health officials to review their plans immediately and “work to ensure that the maximum number of doses is delivered to those at greatest risk as rapidly as possible.”
Frieden does a good job walking the line between thanking public health officials for their hard work—they are, after all, on the receiving end of vaccine frustration—and making it clear that they need to abide by the recommendations. Now it’s up to the vaccinators to listen.
Frieden’s letter in full:
November 5, 2009
Dear State/Local Health Officer:
Today we have 35.6 million doses of 2009 H1N1 vaccine allocated for ordering, with more coming every day. As you know all too well, at present, demand for the vaccine in your communities still exceeds the supply we have received from manufacturers. That means it is more important than ever to focus on ensuring equitable access to the vaccine for the priority groups identified by the Advisory Committee on Immunization Practices: pregnant women, caretakers of infants less than
6 months of age, health care workers, children and adults with health conditions such as asthma or diabetes, and people under the age of 25.
These are the people who are most vulnerable to 2009 H1N1 influenza, and it's our job to do everything we can to keep them safe this flu season.
I know you have been working hard to distribute vaccine to the people who need it most. You are on the front lines of the fight, and no one knows better than you how to reach people in your communities. I especially appreciate the many innovative ways you've found to reach them, including school-located vaccine clinics, special clinics for pregnant women, outreach to children with special needs, and making vaccine available to community- and faith-based organizations serving these high-risk populations.
The goal of the H1N1 vaccination program is to protect our population - focusing first on these high-risk groups and ensuring equitable access to the vaccine. While vaccine supplies are still limited, any vaccine distribution decisions that appear to direct vaccine to people outside the identified priority groups have the potential to undermine the credibility of the program.
It is important to make it clear to the public that we are all committed to the science-based vaccination recommendations established by the Advisory Committee on Immunization Practices. This may include making clear to the public as well as health care providers how the vaccine available to you is being targeted, and the basis for targeting. CDC expects all grantees to ensure that all vaccinators chosen by state and local health departments adhere to those recommendations. Toward that end, and in light of changing projections of vaccine availability, I ask each of you to review your plans immediately and work to ensure that the maximum number of doses is delivered to those at greatest risk as rapidly as possible.
I know how difficult your jobs are; we are ready and willing to help you any way we can.
Sincerely,
Thomas R. Frieden, M.D., M.P.H.
Director, Centers for Disease Control and Prevention, and Administrator, Agency for Toxic Substances and Disease Registry
Claudia Kalb is a NEWSWEEK Senior Writer
