Federal health officials are trying to shift supplies of the seasonal-flu vaccine away from chain pharmacies and supermarkets to nursing homes, hoping to counter a shortage that threatens to cause a wave of deaths this winter among the nation's most vulnerable population.
The extent of the shortage is still unclear, but Janice Zalen, the director of special programs for the American Health Care Association, which represents 11,000 nursing homes and assisted-living facilities, called it "a very big problem."
Zalen said that of 1,000 nursing-home managers who responded to a survey by the association, 800 reported they could not get enough vaccine.
Dr. Carol Friedman, the head of adult immunization at the Centers for Disease Control and Prevention, said she did not have a figure for the size of the shortage, but, "It's a problem, and it's all over the country."
Mary Hahn, who manages six Ohio nursing homes with 800 beds, said she could not get vaccine for any of her patients.
"It's just so disheartening, because we're having to leave people unprotected," she said. "You see people get flus and get sent to the hospital because they really can't fight it off."
A nationwide shortage of the seasonal-flu vaccine has been reported for several weeks, but nursing homes and their suppliers have grown more alarmed in recent days. Of the 36,000 Americans who die of seasonal flu in the average year, more than 90 percent are 65 or older. Nursing home outbreaks are particularly deadly. By contrast, swine flu has been most deadly among younger people.
The nursing homes' predicament has been caused by a confluence of factors. Because of the swine-flu pandemic, far more people than usual are seeking vaccination, Friedman said -- even though the seasonal vaccine does not protect against swine flu.
The five companies licensed to make flu shots for the United States originally planned to make only slightly more than the 118 million they made in 2008. Then, production problems caused GlaxoSmithKline to cut its run by half; Novartis' shrank by 10 percent. Then all five companies had to switch over to making swine flu vaccine.
The total supply of vaccine is about 114 million doses, of which about 95 million have been shipped.
Also, reports of price gouging have grown more frequent. That also happened in 2004, when sterility problems at a British plant cut the American flu vaccine supply in half; prices shot up as high as $90 a dose, from the average level of $8 to $9.
Gouging is illegal in about half the states, but each state varies in how big a price increase constitutes gouging and as to whether an emergency must have been declared for the law to kick in.
"To pursue a case, we need to show it's not just a couple of dollars but is very significant," said Attorney General Richard Blumenthal of Connecticut, one of two states to have opened investigations. (The other is Mississippi.)
Criminal charges are less likely than a civil suit, Blumenthal said. But he said that if distributors were "masquerading or fraudulently claiming to have vaccine," that could end in a criminal charge.
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