Update on Influenza Vaccine Situation
November 9, 2004
DR. GERBERDING: This is Dr. Julie Gerberding, the director of the Centers for Disease Control and Prevention. Thank you for joining us for this
telebriefing today so that we can give you an update on some of the relevant aspects of the flu season. What we're going to be focusing on today
is the plan for allocating the remaining doses of vaccine to help ensure those who need it the most are able to get it.
I'm joined on the call today by Dr. Mary Selecky, who's the secretary of the Washington State Department of Health and the immediate past
president of the Association of State and Territorial Health Officials. I'm also joined by Mr. Pat Libby, who's the executive director of the
National Association of County and City Health Officials. Both of these individuals represent organizations that have been always bright stars in
the world of public health, but their stars have never shown brighter than in the context of what they have been doing to step up to the plate and
really protect their citizens across the state and local health departments and across the country. I'm absolutely awed and impressed by the job
these folks have done to support public health and help this process go as smoothly as possible.
Let me just give a couple of sentences about how the flu season is going this year. At this point in time, no states are reporting widespread
flu activity. Flu is present in 29 states, but what we're seeing right now is well within normal for this time of year, and we're certainly not
seeing the kind of widespread activity that we saw at the same time last year. So that's good, and it means that we're getting these doses out
before the flu season really has revved up. Of course, as we always say, influenza is unpredictable, and we'll certainly be providing regular
updates as the flu season unfolds. That information is also available on CDC's Web site, www.cdc.gov.
What we're really announcing today is a plan that CDC and state and local health departments and Aventis have been working on to make sure that
the remaining doses of vaccine are distributed in the fairest way that we can. We are working hard to make sure that every dose counts. We also
continue to be so thankful for the many people across our country who have stepped aside to allow those who need these doses to receive them. That
includes individuals, but it also includes businesses and health care facilities and a lot of other organizations who have really chipped in to
make this reallocation process have the best possible outcome for our vulnerable populations.
The plan that we're presenting today is the plan that was evolved in phases since October 5th, when the shortage of flu vaccine was first known
and the ACIP offered recommendations for who the high-priority groups should include. The CDC and health officials have been working very hard to
get doses out as fast as they leave the manufacturing process at Aventis. And again, the incredible collaboration we've had with Aventis, with
Chiron and Chiron distributors, as well as the health officials and the people across our country, I believe in my experience this has been
unprecedented in the history of public health.
As of November 1st, approximately 11 million doses of vaccine were remaining. Those doses will be shipped to health departments as they emerge
from the manufacturing process. About 3.1 million doses will be distributed to states to ensure that we can fulfill 100 percent of their contracts
with either Aventis or Chiron. So what that means is the process will ensure that 100 percent of the public sector orders from the states are
completely filled regardless of which company they had originally placed that order with.
There are some local public health agencies who ordered vaccine directly from the many Chiron distributors and/or through Aventis
subdistributors, rather than through a federal or state or multi-state contract. We're not filling these small orders through the state allocation
process at this time. Rather, those orders will be filled as the states receive their apportionment and make decisions about where the local needs
are the greatest.
So we're really urging local health departments, if there's someone who has ordered vaccine from a subcontractor or a distributor, to be sure
and let the state health department know that you're still missing your orders of vaccine.
In addition, over the next two weeks, about 7.2 million doses of vaccine will be apportioned to each state in total. So each state will get a
fraction of that 7.2 million doses that's based on the proportion of the unmet high-priority needs that that state had encountered.
In other words, we're using a formula that both state and local health officials have developed in conjunction with CDC, that asks the
question, what is the gap between the number of high-priority people we suspect exist in that state, the number of doses that have already been
shipped, and then applying that to the national gap as a fraction to give us a percent. Then that percent is applied to the number of doses we
have for the apportionment, so that each state gets its fair share based on the doses needed to best cover their priority populations.
Once the state receives their allocation of the vaccine, they will then allocate it to the appropriate individuals or agencies where the need
is the greatest and they can do the best job possible to get the doses to the people who need them the most.
So that is really in a nutshell what we're announcing today. We're announcing that the state vaccine has been apportioned, and that in addition
we're able to honor the full public sector contracts to the states.
One other important piece of information, we think for people, is that the CDC hotline, 1-800-CDC-INFO, is available 24 hours a day, 7 days a
week in English and Spanish. And it is going to be advertised to help individuals across our country learn, first of all, do they need the
vaccine, but also to help support their referral to the local or state health agency that can help them identify where the doses might be made
This hotline is also a tool that can be used to report things like price gouging or to bring other important issues to CDC's attention so that
we can work with our partners in state and local agencies to deal with the problem.
So let me ask if Dr. Selecky would be willing to provide a few brief comments from the perspective of a state health officer. And, Mary, let me
just tell you, thank you personally for everything that you've done, and your leadership, along with George Hardy and others in the states to
bring us to this point.
DR. SELECKY: Thank you, Dr. Gerberding.
This is Mary Selecky, Secretary of Health in Washington State. I need to let you know that in all the states and in our territories we've been
working very closely with local health departments and health care providers to determine where the most urgent needs are.
What we just heard from Dr. Gerberding is that this new allocation will help us vaccinate more people in the high-priority groups, but we all
have to remember that there's still not enough vaccine for everyone who needs it. So we really need to make sure it gets into the right high-
The shortage can't be fixed at this point, but really, the formula and the allocation plans will assure that the available flu vaccine is
allocated in the fairest way possible. This is truly high-level collaboration. We all have the public's health at heart, and this is our highest
Protecting people from flu will take vaccine, but it will also take some common sense messages and we also want to make sure that people do
things like wash your hands, cover your cough, stay home if you are ill. I think those are as important messages as the strategy to get the
vaccine into our high-priority groups.
So thank you again, Dr. Gerberding, for the collaboration with us at the federal, state and local level, and for all the collaboration that
we're all doing in this country with our providers and our communities.
DR. GERBERDING: Thank you so much, Dr. Selecky.
Now, let me also ask Mr. Pat Libby, who's the head of the National Association of City and County Health Officials or NACCHO, if he could make
a few comments. Pat?
MR. LIBBY: Thank you, Dr. Gerberding.
Local public health supports the flu vaccine allocation method that you've just announced. It is clearly a reflection of our country's public
health system, federal, state and local, working together in the interest, as Mary Selecky just said, of the health of our entire public. We see
it as the best available solution for getting the remaining vaccine to the persons who need it most. Local and state health officers, working with
their health care providers and facilities, will be making some very difficult decisions, and decisions will differ community to community and
state to state based on the needs and on the available vaccine.
As was just mentioned, the difficulty, of course, will still be associated with the shortage and the potential demand. The nation's local
public health departments will continue to assist their communities and their state health departments in every way possible to protect the
public's health during this period of flu vaccine shortage.
DR. GERBERDING: Pat, thank you very much.
Now I'll turn the call to our moderator, who can open it up for questions.
OPERATOR: Our first question comes from Miriam Falco of CNN. Your line is open.
QUESTIONER: Hi, Dr. Gerberding. Thanks for having this. Two quick questions.
Can you tell me if the states that are currently reporting flu activity, will that give them a higher priority to get some of these remaining
doses versus the states that have none? Or can you give an actual example of the gap between what's going--where the vaccine that's coming out is
going to go to versus what's needed?
And, also, can you give me a concrete--or maybe the other folks can give us an example of how people who've been in the highest risk groups who
think they need a flu shot, they should get done, how they can get one if they're not in a nursing home or some of these other places where it
might be a little easier to be registered as someone in need?
DR. GERBERDING: Thank you, Miriam. Let me try to recap your questions. Usually you only ask two questions, so thank you for your three
The first issue around the allocation based on flu activity, the total apportioned doses are not taking into consideration flu activity, but
the order of the shipment from Aventis will include that as one of the elements of prioritization. So if there's an area that is showing
accelerated flu activity, we would try to move them to the head of the shipping line and make sure that doses get there first.
The gap between the number of high-priority people we have in the United States and the total number of flu doses we have at this point in time
is difficult to calculate accurately on a state-by-state basis because we're not sure how much vaccine that went out before the shortage was
announced was utilized for high-priority versus other individuals. So that's not something that we're prepared to assess at this point in time. We
may have more information about that as we go forward. But the bottom line is that we estimate from census data that there are approximately 90
million people in the United States that would fall into that category. Generally, we vaccinate less than half of those people in normal years,
and even last year we vaccinated half of that 90 million people. But the 61 million doses that we have this year so far will go to those people to
the extent that we can do that with this reallocation process.
And, of course, I've forgotten your third question.
DR. GERBERDING: If we can go to the next question and come back to Miriam if you capture her.
OPERATOR: Thank you. One moment.
Our next question comes from Denise Grady of the New York Times. Your line is open.
QUESTIONER: Hi. Thank you very much. I wonder if you could update us, please, on [inaudible].
DR. GERBERDING: I'm sorry. We lost you.
OPERATOR: Denise, your line is open.
QUESTIONER: Okay. Thank you. I'm sorry. Should I start again? I was asking if you could update us on the status of the efforts to acquire more
doses of vaccine from Europe, and I wondered also if the CDC is involved with the states that seem to be going about this on their own trying to
get vaccine. I know Illinois and New Mexico, the governors have said that they have located vaccine that they want to purchase for their own
residents, and I wonder if that's been coordinated at all with any of this allocation or with what the CDC is doing.
DR. GERBERDING: Thank you. Right now, of course, we're talking about the 61 million doses that we have in hand from Aventis and the FluMist
situation this year. Of course, we look forward to the acquisition of additional doses from international sources. The FDA and others in the
Department of Health and Human Services are aggressively working on that. IND discussions are underway to figure out how we would be able to
procure and utilize these doses. So that process is going on in parallel with this apportionment and allocation plan we have right now.
We look forward to being able to augment this plan, but our priority at this point in time is to get the doses we do have to the people who
need them the most.
OPERATOR: Jacob Goldstein with the Miami Herald, your line is open.
QUESTIONER: Thank you. Dr. Gerberding, I wondered if you could tell me if there is any chance or what the chance is that the CDC will issue
guidance on sub-prioritizing high-risk groups to receive flu vaccine?
DR. GERBERDING: Thank you. As you know, we have had a variety of local strategies for making decisions about who among the high-risk patients
will get vaccine first. We've also had some input, some emphasis about the various parameters that should be taken into consideration when we look
at that. I think right now the CDC perspective is that we understand that the state and local health officials are very capable of making those
kinds of decisions as part of their statutory authority and their responsibility, and we're very impressed with the equity and the principles of
equity that they've been utilizing, as well as Dr. Selecky said earlier, some good common sense.
So I don't think we're planning to issue any formal recommendations about sub-prioritization this year, but we are evaluating how the vaccine
is being used, and that may be something that we would take into consideration in future years.
OPERATOR: Miriam Falco with CNN, your line is open.
QUESTIONER: Hi there, again. So does that mean, in lieu of what you just said, that you're still consulting with the ethicists to come up with
something? And then the question I had before for Pat Libby and Ms. Selecky was how do people who don't have a flu shot yet, who should get a flu
shot, find out from their local health departments where they can get one?
DR. GERBERDING: I don't think we will be expecting CDC subprioritization guidelines this year. But the input from the ethicists is ongoing
because it's very important that we use that as a check and balance of the decisions that we are making and there are additional issues that may
emerge as we go forward in the season. For example, if we receive vaccine on an IND, there may be ethical issues around how that's used, that we
would want to be sure whatever scientific decision we're making from a public health perspective, that we have the best input from those who have
special perspectives and really can help us frame our decisions to include ethics as a primary motivating factor.
I'll ask Dr. Selecky to answer the question first, and then Pat Libby--if you have anything to add, please chime in.
DR. SELECKY: Let me give you a few scenarios as to what I know is going on across the country. The collaboration between those who have the
vaccine--sometimes it's a grocery store, sometimes it's a drugstore, and sometimes it's the health department or a health care provider--those who
have the vaccine are working very closely with state and local health to make sure that we get the message out that the folks in the high-priority
groups are who should line up. So that's absolutely essential.
In one of our communities in Washington State, for example, the local health department helped assess people who were in line and asked people
to step away. When our local communities get a shipment of vaccine, they work with their local media, they get the word out. And because the
vaccine is coming as it's produced, we're able to say let's encourage having people take appointments. We all know that there were many instances
in October where people just lined up for hours and for blocks. And now, as we know smaller amounts of vaccine are becoming available on a weekly
basis, we can do it with a bit more organization.
The other thing that's going on in communities is incredible sharing, or reallocation, at the community level-- making sure that our long-term
care facilities are covered; working with health care institutions to make sure health care workers who fit the group who can get FluMist, get
FluMist; and that we make sure we're cued up, as vaccine flows, to take care of those high-priority groups.
Yesterday I was on a call with about 10 of my state colleagues, and we shared information state-to-state. It is an incredible opportunity for
collaboration and cooperation at the state and local level, given the limited number of vaccine available.
DR. GERBERDING: Thank you, Mary. Pat, do you have anything to add?
MR. LIBBY: Two things that I would say quickly to that in a fairly basic message. To an individual, the first message would be to check with
their own health care provider and then talk with--and hopefully, that health care provider has been communicated with by their health
department--or check with the health department. They are in the best position to know where and when these clinics which Mary just spoke to,
which are going to be smaller in scale, are coming on-line as the vaccine is available.
But I think Mary's point also is an important one. As soon as the afternoon of October 5th, there was voluntary private and public, even across
jurisdictions, reallocation efforts underway, and those have continued.
DR. GERBERDING: Thank you, Pat. Let me just add that if a person can't find information from their local or state resource, they can use the
CDC hotline at 1-800-CDCINFO to get that information.
OPERATOR: Our next question comes from Jeanette Barnes of the Standard Times.
QUESTIONER: Hi, Dr. Gerberding. This is my first time calling. I'm at the Standard Times in New Bedford, Massachusetts. Thanks for taking my
You mentioned the 3.1 million doses will be fulfilling state contracts. Does that mean that 7.2 million would be destined for private
physicians? I have been hearing that you were preparing to make an announcement specific to private physicians who had ordered directly from
DR. GERBERDING: Thank you, and welcome to the briefing. The 7.2 million doses will be apportioned to the state, and the state health officers
will have the responsibility for determining where within the state those doses may go. They could go to private practitioners, they could go to
nursing homes or any of the other entities that are still experiencing unmet needs. But the decision about that allocation will be based on the
best available local and state information and, therefore, the state health officers will be responsible for exactly where it ends up.
OPERATOR: Our next question comes from Garrett Condon of the Hartford Courant.
QUESTIONER: Yes, Dr. Gerberding, I'm wondering two things. One is the numbers don't quite add up, with 3.1 and 7.2 exactly to--are there some
doses going elsewhere?
The other thing I wanted to ask is how--Aventis has said it will make available some 2 million doses in January. How will those doses be
DR. GERBERDING: Thank you. First of all, keep in mind that as doses come from the manufacturer, there's always a little bit of leeway one
direction or another because they can't predict in advance what their yield will be. So we have to factor in a small element of uncertainty just
on that basis.
Then in addition, we are holding back a few doses. About 1.3 million doses of vaccine will be retained by CDC to make sure that we have some
flexibility should we develop an unexpected or unpredicted pediatric or adult situation where there is an urgent need for additional doses.
The 2.6 million doses that Aventis was able to project recently are included in the apportionment that's going on right now.
Next question, please?
OPERATOR: Our next question comes from Lee Hopper of the Houston Chronicle. Your line is open.
QUESTIONER: Thank you. This may be a little redundant, but what I was still wondering is can you explain how high-risk patients who usually get
their flu shots through private providers, should try to get one now? I'm thinking in particular of people who have had organ transplants who
aren't part of the public health system.
DR. GERBERDING: Again, the urgent requirements for vaccine are best communicated to local and state health officials, who have been reaching
out to identify the facilities and the hospitals that still are in need of vaccine, and I'm sure are taking that into consideration as they factor
in not only the doses that are received, but who will be receiving them first.
So, I know this is unsatisfactory to the people who are still waiting to know, but I feel that this is a fair process, and I can't tell you how
impressed we are at CDC with the urgency and the commitment that the state and local health officials are placing on this situation for their
citizenry. So vaccine is coming, and it will come in the best possible way to get it to the high unmet needs in the state and local communities.
Next question, please.
OPERATOR: Our next question comes from Paul Shinn of the New York Daily News. Your line is open.
QUESTIONER: Hello, Dr. Gerberding. If I could go back a week, there were a couple of papers talking about low-dose intradermal injections last
week, and I was wondering if there's any effort on the part of the CDC to formulate some kind of plan to possibly use low-dose intradermal
injections in future years, maybe as early as next year?
DR. GERBERDING: I think, as Dr. Fauci and others pointed out, this is a promising strategy that might allow us to make the vaccine we have go
farther, but it's also important to appreciate that it was not something that was demonstrated to be effective in the people over 60, and probably
won't be effective in the people who need vaccine the most. So it might help us in some populations, and we need to do more work to prove that it
not only gets antibody titers, but that it also prevent flu. But in addition it's not the solution for the high priority--for most of the high
Next question, please.
OPERATOR: Our next question comes from Jackie Jeternack of the Albuquerque Journal. Your line is open.
QUESTIONER: Thank you. Dr. Gerberding, I don't really feel that you answered Denise Grady's question about your position on states like New
Mexico and Illinois pursuing independent supplies of the vaccine from Europe. I was wondering if you could tell me if you're encouraging or
discouraging such approaches, what you are telling those states if anything? And if the do indeed get independent supplies, do you have concerns
that that would result in unfair allocations of the vaccine around the country?
DR. GERBERDING: Thank you. I actually didn't hear the earlier questions. I apologize to Denise for not addressing it.
The issue of obtaining vaccine independent of the FDA licensed and approved process is something that we're not encouraging from a CDC
perspective. I know FDA is working very hard to identify the doses of vaccine from international resources, and we're working in parallel with our
current apportionment process to develop mechanisms to fairly distribute whatever vaccine resources we can get that way. But we understand the
predicament that states are in, and we can fully appreciate why they would be looking for innovative ways to find alternative resources.
We'll just do the very best we can to expedite getting additional doses to the U.S. so that all states can benefit from that.
I'll be able to take two more questions.
OPERATOR: Our next question comes from Ceci Connelly of the Washington Post. Your line is open.
QUESTIONER: Hi, thank you. Dr. Gerberding, as you know, I'm not very good at math, so I'm going to ask if you could just walk us through these
numbers. You've used the total 61 million. You've talked today about 2.5 million coming from Aventis sometime in January. There have been the
figures 3.1 million, 7.1 million. Can you kind of walk us through how many doses coming from each place in what kind of a timetable, and does that
add up to your grand total of 61?
DR. GERBERDING: Ceci, first of all, we have MedImmune doses included in the 61 million total, so this is not just the Aventis doses. We'd be
happy to walk you through those numbers offline. Tom Skinner can make that information available to you.
My last question, please.
OPERATOR: I'm showing no further questions.
DR. GERBERDING: Again, thank you to everyone who joined the conference call. We really appreciate your interest, and we will of course be
updating you on further developments as we go forward in time.
And thank you to everyone who's been so collaborative and helpful in this process, and especially to Dr. Selecky and Mr. Libby for
participating and for their constituents at ASTHO and NACCHO, who are doing such a wonderful job for our country, and to all my colleagues at CDC
who are working around the clock on this with Aventis. Thank you.
[End of teleconference.]
Listen to the telebriefing