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NATION NEEDS TO OVERHAUL ITS FLU VACCINE SYSTEM

For the first time in 15 years, the Visiting Nursing Association of Western New York will not be administering flu shots to the community. The announcement of supply contamination by one of the two flu vaccine producers has put a temporary end to a great community health tradition.

We had planned to distribute more than 35,000 doses in 350 clinic sites all over the region, including senior citizen centers and nursing homes, where highly vulnerable elderly depend on us for protection from the flu. In total, we estimate that at least 20,000 of the shots we planned to administer were targeted for the "at-risk" population as defined by the Centers for Disease Control and Prevention: senior citizens, the chronically ill and young children.

The flu kills 36,000 people in the United States each year under normal conditions. That total will undoubtedly rise with this year's vaccine shortage. To put that in perspective, traffic accidents kill 40,000 people annually. To a healthy adult, a bout with the flu results in a few uncomfortable days in bed. To a frail senior citizen, it is a life-threatening event.

Why has this happened? With no direction from our federal policy-makers, the production of vaccines of all types has been left to the open market. Vaccine production is a long, complex process with high start-up costs, and equally large liability risks. Each year's flu vaccine has to be customized to address the season's expected flu strains.

On top of the high cost of production, reimbursement for flu vaccine is very low. Typical of our system of funding health care, we are willing to pay thousands of dollars to treat existing disease, but grossly underfund disease prevention. Consequently, there are very low profit margins on vaccine production.

The result? In 1967, there were 26 companies in the vaccine business. Today, we are dependent on just two.

This year's vaccine shortage is a product of failed public health policy. It should outrage all of us that the situation has been allowed to continue unabated despite frequent annual warnings from experts in the field.

The nation needs to take proactive steps to avoid future shortages. CDC Director Julie Gerberding has pleaded for drastic changes in the way we produce vaccine. She recommends a government-private sector partnership, including using federal tax breaks to increase the number of vaccine manufacturers, and easing the rules for importing foreign-made vaccine. Most importantly, she calls for raising the price paid for flu vaccine by insurers, and making flu vaccine coverage mandatory for private insurance plans.

In addition, the federal government needs to maintain a stockpile of available vaccine each year to counter the impact of potential shortages. This year, only 54 million doses of flu vaccine are available, far short of the needed 100 million doses. Still, the remaining supply would be sufficient to protect the at-risk population if there was a rational system for distributing the supply. Unfortunately, there is no such system. Communities lucky enough to purchase from the one available supplier may have enough vaccine. Many other communities will have severe shortages. I have no idea where Western New York falls on that scale.

The health of our community should not depend on luck. A federal stockpile of vaccine could prevent that from happening in the future.

For now, the VNA of Western New York stands ready to restart our campaign, focusing on our high-risk population, should any vaccine supply become available. I am not optimistic, and will be praying for a mild flu season.

The most fragile people in our community deserve much better. With lives at stake, it is unconscionable for us to allow the current system to go on.

Larry Zielinski is president of the Visiting Nursing Association of Western New York.