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Update on the Influenza Vaccine Supply and Distribution

November 10,  2005

DR. GERBERDING: Good afternoon. Thank you for joining us for this update on influenza. I think the news has been full of information about pandemic influenza and pandemic planning. Today's discussion will be more about influenza distribution and the difficulties that we're having identifying at the local level supplies of vaccine.

One piece of good news to start off with is that this year's flu season has not gotten off to an aggressive start and we have less flu in the country than at the same time last year. States are showing sporadic or no flu activity of no states in the pink, purple or red which would indicate more widespread flu. So that's a good thing because it gives us time to get the vaccine out there. More vaccine is coming. People still have many opportunities to get vaccines. We'll talk a little bit more about what the actual supply situation is at the local level and why we might be having this challenge this year.

As you know, so far at least 71 million doses of influenza vaccine have been distributed. We expect by the end of November we will have distributed more than 81 million doses of vaccine. That is close to the highest amount of vaccine we've ever had available, and depending on the supplies that emerge in December toward the end of the manufacturing cycle, we might actually end up with the most ever influenza vaccine for the country.

What is going on at the local level now is that some vaccinators including physicians and clinicians in office practices are having trouble getting vaccines. One of the reasons for this is that Chiron was not able to get their vaccine out as fast as they would have liked. They're also not producing as much vaccine as they had projected at the beginning of this year. Many clinicians order their vaccine from Chiron. They've been one of the important distributors to that sector. So those clinicians are delayed. My own mother called me this week because her doctor told her that her vaccine was not available. She wanted to know if she should go to the neighboring state to get her shot. The first question I asked her was, is there a flu outbreak in the community and she said, no. I said, when does the doctor think he'll have the vaccine and she said, by the end of the month. I said, good, you'll get it in time. Just wait and make your appointment so that you can get it when it's available.

We also know some good news about pediatric vaccines. Doses of vaccine especially formulated for children have been distributed. We don't seem to be experiencing any significant shortages of vaccines for children.

If we continue along this track of the production coming out of the manufacturing and distribution process as we predict and the demand being constant as we're still primarily in the pre-peak season of influenza, we expect we'll have time for most people to receive their vaccines.

There was focus this year early on on the most priority groups, the people at greatest risk for flu complications. Those people did get a head start, and in most communities that has resulted in the people at greatest need for the vaccine getting it and getting it now.

We're doing some additional things to help out. I think everyone appreciates that the government and CDC in particular does not own very much flu vaccine. Unlike the situation of vaccines for children, the vast majority of flu vaccine is in the private sector and we have very little capacity to move vaccine around. So what we are doing is preparing our own stockpile of vaccine, getting about 800,000 doses of vaccine from Chiron at the end of November, and we'll use those doses to help offset shortages in communities where there is no one with vaccine available. So in those locations where the clinics have been closed and the doctors don't have vaccine, CDC will be able to offer a little bit of help and potentially even more help in December.

We also have wonderful cooperation from our health officials and folks in the immunization programs across the country who are working on solving local distribution problems. The National Association of County and City Health Officials, this is an association that represents local health officials, and they're going to do two things. One is that the many local health departments will work directly with the health care providers to try to make sure that the people at highest risk for flu complications do get the vaccine first at the community level. What that means is that in some communities the specific advice about vaccine availability may differ than is present in the nation as a whole or even in a neighboring community. So people need to pay attention to what their local health officials are saying about the availability of clinics, where to go to get vaccine and who should be prioritized to receive it.

Many health officials are also really going to help with the redistribution process, so they're reaching out to find out who has surplus vaccine, who still needs doses, and they'll work on trying to redistribute that at the local level.

We are also continuing to recommend that people who are healthy between the ages of 5 and 49 years of age remember that there is another alternative for them. The FluMist vaccine that's made by MedImmune is a nasal vaccine. This is an excellent vaccine for healthy people. It provides wonderful immunity. It might even be even more efficacious than the standard flu vaccine, and it's something that we would really encourage for those people who can't find a flu shot but are in that 5 to 49 year old age range where FluMist is a great option.

From a long-term perspective, look upon this as a situation that has a solution in sight. This past week the President announced a budget proposal for $7.1 billion for pandemic influenza. A solution to create manufacturing capacity and modernize flu vaccine manufacturing capacity to solve a pandemic problem is exactly what we need to solve the seasonal flu problem, and I think we in public health all recognize that in the future we'll be able to get influenza vaccine shortages off the table and really help reduce some of this incredible frustration that people experience worrying about whether they can get a flu shot or the inconvenience about having to stand in line and reschedule appointments and so forth when the shot isn't available when expected.

So in the long run, the solution is in sight. We wish we had that solution today, and we're sorry that we don't and we're sorry that we have another frustrating year for some people. But the big picture here this year, unlike last year, we expect many more doses of flu, and there is still plenty of time for people to get vaccinated. So that's part of our message, if you can’t get it right now, be persistent and patient if you can and check back with your physician because you may be able to get your shot a little bit later this month or next month, and that's, I think, the overall important message.

We also want to really thank people who have been patient this year. We thank the clinicians who are vaccinating and the clinicians who are still waiting for their vaccines. We especially thank all the people in the state and local health agencies who are working so hard at the local level to redistribute vaccine and to put the information out to people to reassure them that more vaccine is coming and that we're doing everything we can to try to get it to them and into their arms as quickly as possible.

Thank you for your attention. I know there are more than 400 people on the telephone with questions, so I'd like to start with the telephone questions first. May I have the first question?

While we're waiting to get the question in, I'll go ahead and take a question from the room.

MS. McKENNA: Maryn McKenna, Atlanta Journal-Constitution. There have been numerous anecdotal reports from across the country that places that are providing flu shots are experiencing what they perceive as higher demand than in past years. Do you have any sense of that being reported either anecdotally or otherwise?

DR. GERBERDING: Our impression is demand probably has increased, but we don't have the solid data yet. We're in the process of getting that surveillance information together and collated so we'll be able to get an update on the exact perspective soon.

But based on what we've seen so far from our own information sources, we suspect that there are two things that are driving this. One is last year's shortage, so more people wanted to be vaccinated early, being fearful that maybe more vaccine wouldn't be available. Second, we've been putting an awful lot of attention on pandemic influenza, so influenza is on people's minds and I think the factor of pandemic influenza is very frightening to people. Although the seasonal flu vaccine certainly does not prevent avian influenza, it does remind people about the importance of influenza as an illness and it wouldn't be at all surprising if more people were motivated.

In the long run that's a great thing. I think we all know that in our country today, without any additional changes in our immunization recommendations, more than a 180 million people [are recommended to get] vaccine. We've never come anywhere close to that.

In fact, we've never even gotten a 50 percent demand for vaccine. So if we can get more people interested in immunization, that's a good thing for them and I think it's a good thing for the public's health.

I'll take a phone call now.

OPERATOR: Thank you. The question comes from Miriam Falco with CNN Cable News. Your line is open.

MS. FALCO: Hi, Dr. Gerberding, thanks for taking our questions. I have two questions. I'm cheating again. To follow up on what was just asked, why do we need to have the fear, or the idea of a shortage to get folks to get their flu shots? And what has--if you can answer this--has come out of the Geneva conference on pandemic flu, that builds on what was announced last week from the President's preparedness plan?

DR. GERBERDING: The reason why people are not motivated to get a flu shot under ordinary circumstances is complex. I don't think we have a full answer. I wish we did. But certainly flu is something that for most people is such a benign illness. Many people don't appreciate that it can result in hospitalization, various complications. For about 36,000 people every year, death.

I think as a society, we drastically underestimate how important flu is to our health and the health status of our families, and we're used to it, and it just doesn't seem like such an important health issue, until you step back and really think about the big picture and look at from a population perspective.

In terms of the conference in Geneva, that meeting is still in progress. We're waiting to hear what final conclusions come out of there.

But I think the big frame is that the health leaders of the world remain in high gear toward pandemic planning. There's nothing that has emerged, that would suggest that there's less threat or less reason to take the steps that we're engaged in right now, and so the importance of really, not only the United States, but all of the leaders of health around the world, as well as the heads of state around the world, are working together, collaboratively, to create a seamless network of protection.

We have a big role to play in that in the United States and I think the leadership that I've seen from Secretary Mike Leavitt and the president and our Congress and the leaders around the world take the steps, but there's a lot of work to do, and we're going to have to be focused on this steadfast way for many, many months, before we really have achieved a level of preparedness.

A question in the room.

QUESTION: Hi, Dr. Gerberding. I believe you had said that we do underestimate the flu, that as many people should get vaccinated as possible. But the question is isn't the fact that there have been some delays in the pipeline this time, is it realistic to expect that we should go ahead, that there should be universal vaccination, and is that even [inaudible]?

DR. GERBERDING: We make steady progress. This year, there are four manufacturers supplying influenza vaccine as opposed to just two last year, and although Chiron has been disappointed in their ability to produce the maximum they had hoped for, they certainly have distributed several million doses of vaccine already.

So we know we can scale up production. The plans outlined in the President's budget initiative really call for two major changes in the vaccine program.

One is to move from the current dependence on [production to] a more modern technology. The other is to be able to scale up vaccine production, so that even if we're using eggs, we can make more doses of vaccine. Both of those approaches are important. The egg-based approach will help us out in the near term, and the modernization and salability of the process will help us out in the longer term.

It's exciting to hear about how many new ideas are coming into development in the companies, incentives that are being offered now should help accelerate that research and development.

So we need to be optimistic, that down the road we'll have the vaccine and that will no longer be the rate limiting [inaudible].

In the short run, we do have to tailor our recommendations and not overstep the supply that we have, and we've learned how challenging that can be.

I'll take a question from the phone.

We've made a change in technology here, so the phone is a bit slow in coming on board. If there's a question in the room, I'll take it while we're waiting for, from the phone.

OPERATOR: Thank you. I do have a question from Maggie Fox with Reuters. Your line is open.

MS. FOX: Thanks, Dr. Gerberding. Can you just expand on that a little bit more? Is this apparently increased demand a good thing, because I know one of the things that the manufacturers said they needed was increased and steady demand for flu vaccine? And Dr. Gerberding, you should note that for some of us on the phone, you seem to be fading in and out. Thanks.

DR. GERBERDING: Thank you for letting me know about the technical issue. We are using new equipment and so you're helping us identify any glitches in our system and I appreciate the feedback.

The issue of demand-supply is one that is a moving target. There is a difference between need, as we define it at CDC, meaning those people who would most benefit from being vaccinated because they have the highest risk for complications, versus demand, which is what are people actually willing to do.

This year, we've had two additional elements of uncertainty. One is the geography of distribution because there is widespread difference in availability at the community level, and the fourth dimension of this is timing.

We've had a very good uptake of vaccine early in the season that we were prioritizing this for the people in the highest risk groups. What we're seeing now is a growing demand among people who might not ordinarily receive a flu vaccine shot.

As a public health agency, we remain very focused on trying to get the people who need vaccine the most vaccinated as the highest priority. But we see a very large benefit, the more people who are willing to be vaccinated, the more vaccine we can use, meaning the more vaccine the manufacturers can sell, and the more supply they will be [inaudible]. So that's part of the solution to the problem.

What the government is proposing is to augment that situation by helping to incentivize the expansion of the manufacturing capability as well as removing some of the regulatory obstacles to moving products through that process.

I can take another telephone question, please.

OPERATOR: Thank you. John Lauerman, Bloomberg News. Your line is open.

MR. LAUERMAN: Hi. Thanks for taking my question. Dr. Gerberding, you talked a little bit about the possibility that this might be the top year for vaccine distribution. Could you just sort of flesh that out a little bit? Are you saying that you could exceed, what was it? 83 million doses? And how would that happen, if we're just expecting 81 million doses now? Just try to explain that for me. Thanks.

DR. GERBERDING: Our projection is somewhere between 81 and 83 million doses, that would be available by the end of November. There are two reasons this year why we can't give a specific estimate. We never know for sure what the concentration of vaccine will be as it comes out of the manufacturer, so the titer of lots can vary a little bit, and sometimes manufacturers can get more doses, sometimes fewer doses than they expect on average. So there is always some variability of the number of doses that can be created.

The second reason for a little uncertainty is we still don't know for sure how much vaccine Chiron is going to be able to produce. They haven't given us a firm figure, though we have some flexibility in our estimates based on their scenario. But typically we continue to produce vaccine into December, and so if we have 81 million doses by the end of November and we get any produced in December, we may very well exceed our 83 million dose all-time high. That's why we have that optimistic projection of having the most vaccine we've ever had.

If we have the most vaccine we've ever had and we have the highest demand we've ever had, we will still be experiencing these frustrations and these difficulties, but we're certainly moving the needle on the dial in the right direction and I think that's good for health and ultimately good for our manufacturing capability.

I'll take a question here in the room.

QUESTION: Could you classify at all the kind of breakdown of the vaccine that's come out thus far? Of that 71 million, how much has come from each manufacturer? And have the other manufacturers other than Chiron contributed?

DR. GERBERDING: Let me tell you what I know right now. I can tell you that about 55 million doses have come from Sanofi Pasteur, about 7 1/2 million doses from GlaxoSmithKline, about a million doses from MedImmune, that's the FluMist vaccine, and about 8 million doses from Chiron. They're ball park numbers I know obviously, but I think that's a pretty good estimate of the most recent information we have.

We expect 10 to 12 million more doses by the end of November. And as I said, the pediatric vaccination doses have already been distributed. So they would not all come from Chiron. There are some vaccines from Sanofi Pasteur as well as from MedImmune. There is more vaccine coming from at least three of the manufacturers. I believe the GlaxoSmithKline vaccine has all been distributed.

I'll take a question here in the room.

QUESTION: The Kuwaitis have a couple of birds with cases of some form of bird flu. There is a large number of Americans stationed there, and it isn't easy to pass from person to person. Have you spoken with the Kuwaitis, and is there concern about any possibility that Americans may come into contact?

DR. GERBERDING: I don't think this is a situation that's limited to Kuwait. We have Americans all over the world in countries with poultry outbreaks, and our advice to Americans wherever they are is that they should avoid contact with poultry, particularly poultry in the rural areas, and they should not go to the [live poultry] markets which are places where birds are caged and sometimes housed in conditions that would promote contact with body fluids and so forth.

Other than that, we have no specific travel restrictions or advice to travelers, but it does point out that the H5N1 avian virus is moving through migratory bird pathways. It won't be at all surprising if some day we see a bird arrive here in our own country with H5N1. That's why the Department of Agriculture and the Department of Interior are doing the kind of screening of birds, the projects in Alaska, to particularly focus in on birds coming through that flyway. Some of that testing, by the way, is done in Georgia at the University of Georgia.

But we also recognize that the whole sentinel system of surveillance in this country is kicked into high gear. Some of the increased resources proposed in the budget initiative will also help our Department of Agriculture expand their bird surveillance so that we have a more seamless network of animal health surveillance and we can connect that with our human health surveillance efforts that are ongoing.

Let me take a telephone question, please.

OPERATOR: Thank you. Mike Stobbe with the Associated Press, your line is open.

MR. STOBE: Doctor, thanks for taking the call. First of all, you mentioned a geographic variance earlier. I know that the Arizona governor had talked to Secretary Leavitt about concerns in that state. Are there particular states where the spot shortages have been most acute?

DR. GERBERDING: We've heard reports from communities across the country of one sort of another, and Arizona was one of the first places that indicated they were having a significant shortage problem. We did commit to try to help Arizona solve its problem. That's why we're looking forward to getting the supply of vaccine stockpiled in case in some areas like that that need an extra boost of doses to help at the community level, not just at the provider level.

But until we get the information in from the systems that we've set up, we're not going to be able to give a precise map. We're just thankful to our local health officials who have been sorting this out and giving us a perspective.

Let me take another telephone question, please.

OPERATOR: Thank you. Lee Hopper with the Houston Chronicle, your line is open.

MS. HOPPER: Thank you, Dr. Gerberding. What measures are you looking at to improve distribution to private practice physicians? We've had a lot of complaints from local doctors who are turning away patients who then swamp the flu shot clinics being held at grocery stores which then has led big shot providers such as Maxim to cancel some of its clinics.

DR. GERBERDING: A couple of things were established early in the year. One was the decision to encourage prioritization of the high-risk groups first, whether it was a provider or a large vaccinator situation. One of the consequences of that is probably as you might imagine, people who place large orders for vaccine tend to get preferential treatment by the distributor because it's efficient and important that they deliver to their large customers first.

Often office practitioners are short of vaccine and CDC doesn't control that, the FDA doesn't control that. That's really a consequence of having the vaccines in the private sector and so that the same kinds of decisions that any distributor or any product often makes.

We have had good cooperation from the manufacturers who have indicated the willingness early in the season to try to ship preferentially to those customers most likely to vaccinate the high-priority groups. That did help us to some extent, but this is a situation that is a market distribution problem that's difficult to fix from a government perspective, and we will continue to try to find solutions.

I think the biggest solution is just to augment the supply of vaccine and get it available on a faster production schedule so that it comes out all at once or in a much shorter time frame rather than having it come out over the whole flu season which means that some people get it early and some people get it later.

Emphasizing again, however, this year we're fortunate in that the flu season is not off to an early start and there is still time for people to get their vaccine. So these doses that are coming will be put to good use and we encourage people to check back with their doctor if they haven't been able to get vaccinated.

I'll take another telephone question, please.

OPERATOR: Thank you, Jeremy Manier with the Chicago Tribune, your line is open.

MR. MANIER: Thanks, Dr. Gerberding. As I remember, I think it was October 25th or 24th you had a press conference saying that as far as you knew then there was going to be plenty of vaccine for everybody and people who were not in the high-risk groups should feel free to get the vaccine. I think it was that day, my employer and lots of other employers that I know of cancelled their flu drives because they were already saying that there wasn't enough vaccine out there.

There seemed to be a disconnect then and in the weeks following of what the CDC was saying and what people were experiencing on the ground. Why was that, and does that bode well for a pandemic situation where the stakes would be much higher and you don't seem to have really gotten the handle on an ordinary flu season yet?

DR. GERBERDING: The CDC and state health departments often find ourselves in the position where recommendations are made about large populations and sometimes those recommendations don't make it to an appropriate level, and that's why we're very grateful that our Association of City and County Health Officials has really stepped up to the plate and have made the decision that they will adjust the recommendations for the broad populations to fit better to the local needs of their communities.

With respect to overall pandemic planning, as I've tried to emphasize, this challenge of vaccines matching vaccine need to vaccine demand to vaccine production to vaccine timing to vaccine geography is going to continue to be a seasonal challenge until we fix the supply of the vaccine. As we look forward to the future where we don't have to have this struggle and this inconvenience for people on an annual basis, we'll do the best we can, but we don't own the vaccine and we really can't force it into particular positions or jurisdictions without that kind of authority. So we will continue to work hard to try to give the best national advice we can with the expectation that in many cases it will need to be tailored to best fit the local situation.

I think what we said on October 24th was based on the perspective we'd received from the majority of health officials around the country which was that the focus on priority groups had taken off and that there was a large amount of vaccine waiting to be administered to people who weren't in that first tier and that it was time to allow people who wanted to the vaccine to be able to have access.

I'll take another telephone question, please.

OPERATOR: Thank you, Ann Walselik with The Morning Call newspaper, your line is open.

MS. WALSELIK: Dr. Gerberding, thank you very much. We're still experiencing or at least I am some sound difficulties.

My question though is to what degree do process and perhaps publicity play a part in who gets the vaccine and who's delivering it in the community?

DR. GERBERDING: I'm not sure I can comment on that. I believe that all of the manufacturers that we're dealing with are certainly ultimately driven to make a fair profit on their product, and so that certainly would play a role in their decisions. I think we've also seen some pretty extraordinary examples of altruism and help from the manufacturers. We just have to look back to last year when Sanofi Pasteur stepped in and took on responsibility for some of the Chiron distribution, where Chiron made available its distribution lists and information to help us identify where the biggest gaps were.

So the distribution is based on the same premises of any product distribution. People will produce their product and sell it where there's a market for it and we've tried to help by purchasing vaccine ourselves and having a little bit of wiggle room to fill in the gaps, but we ourselves have only very limited resources for that purpose and there's not a lot we can do to solve the national problem. We need this investment that has been proposed by the President and by Congress to solve this problem and we really need to drive this home to a solution as quickly as we can.

I'll take another telephone question, please.

OPERATOR: Thank you. Tom Maugh with the L.A. Times, your line is open.

MR. MAW: My questions have already been answered. Thanks, but we're having a lot of problems with you fading in and out particular when the people in the audience talk.

DR. GERBERDING: I really appreciate that. We'll get it fixed for our next press conference. This is our first run here with this new setup.

I do want to make one comment here before we close this press conference, and that is while we've been focusing on pandemic influenza in the long run and seasonal vaccine shortages in the short run, we're also a scientific agency and we've been doing some, I think, astonishing scientific work to really understand the biology of influenza. There was an unfortunate report that appeared in a media outlet today that indicated that CDC was distributing its reconstructed 1918 virus to other parts of the country for scientific investigation. I just want to set the record straight on this. CDC has no plans currently to distribute the reconstructed virus anywhere. We're working on it here in Atlanta. We have collaborations with investigators to come into our campus and who work with the virus here.

This is a special situation. It is now formally classified as a select agent, but even within that context it's still a very special organism because it doesn't exist right now anywhere other than the CDC. So we have a very special responsibility to balance the importance of getting the scientific work done especially if it leads to better vaccines or a better understanding of pandemics.

We have to balance that with our overarching moral and scientific imperatives to make sure that virus is handled with the absolute best possible biocontainment and biosafety procedures. We know we can do that at CDC and we probably will be able to assure that other investigators can do likewise, but until such time as we recognize the scientific merit and the adequacy of the biosafety containment procedures, that virus is not going anywhere and it's not leaving the CDC without my expressed approval.

So I really felt given some news reports that have picked up this fact that I wanted to take this opportunity to set the record straight on that issue and we are taking our responsibility in this regard very, very seriously.

It's outstanding scientific work. We look forward to more understanding of potential pandemic viruses as a consequence of it, but we have a very high regard for the importance of biosafety and we take that very, very seriously here.

Let me just again thank you for being here, thank you for calling, thanks for the feedback on our system. We'll definitely get that fixed, and we appreciate everything that you do to help us fight the flu. Thanks.

Listen to the telebriefing

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