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Behind the H1N1 vaccine shortage in US

Your chances of getting inoculated against America's worst pandemic since the 1918 flu improve greatly depending on where you live.

world Updated: Nov 03, 2009 13:43 IST

Since Sept. 1, there have been nearly 3,000 deaths and 29,000 hospitalizations across America mostly due to the H1N1 virus, better known as the swine flu. The pandemic has been declared a national emergency, with millions of people in search of a potentially life-saving vaccine--and few able to find it. Doctors' offices have received only a fraction of their expected doses; pharmacies have a limited supply; some schools haven't begun inoculating students.

For the moment, the vaccine's availability, it turns out, has a lot to do with something so simple as where you live. In Alaska, there are 85 doses per 1,000 residents--the highest concentration in the country. The number is similarly high in Washington, D.C., and in more rural places, such as Vermont, South Dakota and Idaho, according to an analysis of the latest figures released by the Centers for Disease Control and Prevention.

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Manufacturing delays are to blame. The CDC planned to ship up to 30 million doses by the end of October but had to lower that estimate considerably. Though the shortage continues, there was a surge in supply this week and, as of Oct. 28, 16.9 million doses had been sent to hospitals, doctors' offices, clinics and health departments.

Surprisingly, New York state has the fewest available doses in the country--just 29 per 1,000. Tom Skinner, a spokesman for the CDC, says that the variation reflects the planning efforts in different states. Some may have waited to order the vaccine until they decided precisely how it would be distributed, while others requested their allotments early. As of this Wednesday, Florida had 41 doses per 1,000 people; Michigan had 55; California had 56--all substantial increases from the previous week.

Still, in order to get the vaccine, it's not enough to just live in one of the high-dose states. The shortage has forced many vaccine providers to screen patients and give priority to those at high risk for catching H1N1. And doctors' offices, which should be a patient's first resort, are woefully under-stocked. Until supply increases, the most consistent source of the vaccine will be public health departments, with some retail pharmacies providing shots as often as possible.

Making an Effort

Some public health departments are doing the best to communicate when and where to get vaccinated, despite the shortage.

In Los Angeles County, where more than 3,000 private physicians and clinics signed up to get the vaccine and only about 400 actually did, the Department of Public Health has posted an almost-daily schedule of clinics on its Web site. In late October, the department mobilized employees and volunteers and administered 50,000 free doses in a matter of days.

Dr. Jonathan Fielding, director of public health for the county, says the clinics were initially organized to serve patients with limited access to a primary care physician, but that the department "has not turned anybody away." He encourages patients to see if their primary care physician has the vaccine first--but he also knows the shortage has made that likelihood slim.

"What are you going to do?" he says. "Make 20 calls to doctors you don't know while they're saving it for their high-risk patients?"

However, Fielding has encouraged low-risk patients to reconsider potentially taking a dose away from those at greater risk, such as pregnant women, health care workers, those between the ages of six months and 24 years, and people between 25 and 64 who have chronic health disorders like diabetes and heart disease.

The New York City Department of Health and Mental Hygiene has taken a similar approach. The agency, which had received 380,000 doses as of late October, launched a Web site where residents can track vaccine availability by ZIP code or borough.

The New York City Health and Hospitals Corporation, which provides public health care to 1.3 million city residents, has also set up "fast track" flu centers throughout the five boroughs. Shots are free to children under 20 and to adults who qualify for the discount. Though the vaccine has been paid for by the government, adults who do not qualify for the subsidy will pay $30 to cover the cost of administering the shot.

The city also plans to begin school vaccinations this week, but will conduct them in phases depending on enrollment numbers and the availability of the vaccine.

Friendly Neighborhood Pharmacist

Where public health departments can't meet demand, some retail pharmacies hope to fill the gap. Walgreen's ( WAG - news - people ), for example, is contracted to provide both the H1N1 and seasonal vaccines in every state across the country. The H1N1 vaccine is free, but there is a fee of $18 to administer the shot.

Jack Cantlin, vice president of pharmacy services for the company, declined to disclose how many H1N1 doses Walgreen's has received, but says that it is targeting areas where vaccine distribution was spotty. This has included rural areas or locations where there is an insufficient number of providers for the amount of vaccine that needs to be distributed. Walgreen's employees are also prioritizing shots for those in the high-risk categories.

The company has posted availability of both the seasonal and the H1N1 vaccines on its Web site, which has clinics sorted by major metropolitan area and ZIP code. A handful of Rite Aid ( RAD - news - people ) pharmacies are offering the vaccine in Tennessee, Kentucky, Washington and Oregon, but supply is highly limited, according to Cheryl Slavinsky, a spokeswoman for the company. CVS plans to offer the vaccine, but is waiting for increased supply.

Meanwhile, Tom Skinner at the CDC is hopeful that the shortage will be resolved by mid-November or early December, as the agency has projected.

"The best thing I can say is to contact your state health department to find out where the vaccine will be available," advises Skinner. "By [next month], people won't have to go searching for it."