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Is there a flu vaccine shortage?

Fergus Walsh | 16:12 UK time, Wednesday, 5 January 2011

Whether or not there is a flu vaccine shortage seems to depend on who you ask. Dr Rosemary Leonard, a regular on BBC Breakfast, believes there is.

Dr Leonard, who has a practice in Dulwich, south London said: "There's been a rush on the vaccine and my surgery ran out yesterday. We have 40 people waiting to be immunised who are eligible for the vaccine. They didn't come forward when we invited them a few months ago but they want it now."

Dr Leonard said several other GPs in London have reported similar problems.

But according to a spokesperson for the English Department of Health: "There is no national shortage of seasonal flu vaccine. PCTs are working with their GPs to ensure that local supply issues are resolved locally where possible. "

And a spokesman for NHS London said: "Most GPs in London have a good supply of the flu vaccine. However, some are experiencing increased demand with more people than expected wanting the jab. Where stocks run low, GPs are able to share supplies with neighbouring practices.

It would seem that, overall, GPs still have doses, but there are localised problems with individual surgeries which have run out. The Royal College of GPs told me they were not aware of any major national shortage.

To understand how local problems could occur, it is worth setting out how the system works. GPs order their vaccine direct from the five manufacturers who supply the UK or from wholesalers. It is not the responsibility of the various devolved Departments of Health around the UK.

Doctors are encouraged to place orders by the end of March, because it takes several months to create the flu jab. The only way GPs can anticipate demand is to base their order on previous years, taking into account any changes in the recommendations for who should receive the jab. They don't want to run out, but they also don't want to be left with hundreds of unused jabs. There is an element of guesswork involved.

Vaccine uptake this season has been down on previous years, but there has been a sudden surge in demand since the week before Christmas, when the flu story began to grab the headlines.

Usually GPs get their flu vaccine clinics over and done in October and November, so this is very late in the season to be organising them.

So whose fault is it if a surgery runs out? You could simply blame the GPs for lack of foresight if they ordered fewer doses than previous years. But one can hardly expect them to anticipate a late surge.

What about the vaccine manufacturers? Surely they should have made more - just in case they were needed? Nice idea, but they are, after all, running a business, and it does not make economic sense to throw millions of doses away.

Figures from the UK Vaccine Industry Group (UVIG) show that their companies will have delivered 14.7 million flu doses in the UK this season - similar to the two previous years. Most of these were delivered in October, with 98% delivered by the end of November. So they have fulfilled all their orders.

Richard Stubbins, managing director of Sanofi Pasteur MSD, one of biggest vaccine suppliers, said his company had had more calls yesterday from GPs asking for doses, than they would expect in a week.

Mr Stubbins, also the chairman of UVIG, said: "Most companies keep a bit of extra stock for top-ups when GPs run short, but the demand at this time of the year is very unusual. We have perhaps just 8,000 doses left in the UK - and they are going fast."

The five companies that supply flu vaccine to the UK are: Pfizer, GSK, Novartis, Abbott (formerly Solvay) and Sanofi Pasteur MSD.

UVIG said it would be surprised if other manufacturers had stock remaining.

What about blaming the Department of Health? Last year, the DH took over purchasing and distribution of the pandemic swine flu vaccine. They also do this with most childhood vaccines. But flu, adult, pneumococcal and travel vaccines are left to GPs to order direct.

Some might argue that central purchasing would work better. At present, there seem to be enough flu doses around, but some are lying unused in GP fridges - while other surgeries are crying out for them.

The Department of Health has asked vaccine manufacturers how many UK licensed doses are available that are not yet in the UK. This effectively means vaccine with the packaging and leaflet written in English and another language - dual-labelled.

Richard Stubbins said: "My company is looking for dual-labelled doses from Spain and Italy. But altogether there could be less than 100,000 doses spread among all the companies."

That will be a help, but it represents less than 1% of the 14.7 million doses produced this year.

Another option would be to bring in doses which are not labelled in English. But this raises regulatory issues because the vaccines may be packaged differently and the doses will not be licensed for UK use. It would need the Medicines and Healthcare products Regulatory Agency (MHRA) to approve this, which would take some time. By then the flu outbreak may have peaked.

Regarding blame, we could also try pointing the finger at the private sector for buying doses which will largely go to the worried well. About 700,000 doses - 5% of the total - are sold by the manufacturers to the commercial sector - chemists, supermarkets and private companies - who offer the jab to staff.

But this happens every year. And since the manufacturers have supplied all the doses the NHS has asked for, it is hard to see how one can blame the private sector for using doses that it ordered.

I would prefer not to blame anyone, but rather hope that people who need the vaccine get it. Then perhaps some thought could be given to improving the system for supplying flu jabs in the future.

Tomorrow we will get the latest flu figures which might indicate whether the outbreak is getting bigger or easing off. I hope for the latter but suspect the former.

update 18:15

There seems to be some confusion about what the Department of Health has asked the vaccine manufacturers to do.

A DH spokesperson gave my colleague Nick Triggle this quote earlier today: "We have urged the vaccine suppliers in the UK to be in contact with their factories in Europe to see if more UK licensed vaccine can be brought into the UK as soon as possible."

That seems crystal clear. But Richard Stubbins, of UVIG expressed surprise:

"It is not UVIG nor my understanding that we have been asked by the DoH to bring in any available UK licensed flu vaccines.

They have asked 'what doses there are', that is:
The number of available doses in the UK
The number of UK licensed doses which could be brought into the UK
The number of other (non-UK labelled) doses we have around Europe, which could be brought in (regulatory issues notwithstanding).

They had this information on Monday/Tuesday."

So there you have it. Do the DH want extra doses brought in or not? I will let you know when the situation has been clarified.

update 19:30

I am grateful to Kate Pike the Chief Press Officer at the Department of Health who has clarified the situation. She emailed me this: "It appears that what has happened is that the press officer who was speaking to Nick, gave him a statement before we'd checked it with the experts. The "urgently" and "as soon as possible" bits were taken out, as they weren't true.

So my apologies for that. Completely our fault."

I think it is rather nice when people hold their hands up when there is a mistake. The correct line from the DH is this:

"Vaccine suppliers in the UK are in contact with their factories in Europe to see if more UK licensed vaccine can be brought into the UK. "

So they have not asked them to bring in more stocks yet, but I guess they might do in the near future.

update 21:35

If there are local difficulties regarding vaccine supply, they do not, it appears, apply to Scotland. The Scottish govenrment said in a statement: "There are no supply issues with the seasonal flu vaccine here in Scotland.

Over a million doses of seasonal flu vaccine have already been distributed to GP surgeries and pharmacies, with an additional stockpile available should it be required."

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