The dilemma over how limited supplies of the H1N1 vaccine should be distributed was underscored today as government health officials defended their allocation of vaccine to Wall Street firms. But doctors around the country bristled at this news, asking why these firms can get the vaccine while physicians and hospitals still face shortages.
It is a controversy that prompted a comment from the White House, a letter from the CDC, and protest to congress from a citizens group.
"Greed goes beyond just money," said Dr. Michael Coates, professor of Family and Community Medicine at Wake Forest University in Winston-Salem, N.C., of the news, which first appeared in a BusinessWeek article on Monday. "We have neither the seasonal nor the H1N1 vaccines for our patients. I had several high-risk individuals in my clinic this morning who should get vaccinated."
The report also prompted Citizens for Responsibility and Ethics in Washington (CREW) to demand an investigation into why the Centers for Disease Control and Prevention approved small amounts of H1N1 vaccine for distribution at 13 companies including Goldman Sachs and Citigroup.
Prompted by various news reports about Goldman Sachs officials receiving H1N1 vaccines, White House Press Secretary Robert Gibbs said CDC director Dr. Thomas Frieden sent a letter to states reiterating the importance of vaccinating priority groups.
Frieden said in his letter, "The goal of the H1N1 vaccination program is to protect our population -- focusing first on these high-risk groups and ensuring equitable access to the vaccine. While vaccine supplies are still limited, any vaccine distribution decisions that appear to direct vaccine to people outside the identified priority groups have the potential to undermine the credibility of the program."
But because the vaccine is actually distributed through state health departments, the CDC may have little direct say in this matter. Moreover, some experts say that allowing large companies and businesses to become points of distribution for vaccine may be logical.
"When you make [vaccination] easy and accessible to people, you improve immunization rates," said Dr. Gregory Poland, director of the Mayo Vaccine Research Group at the Mayo Clinic in Rochester, Minn. "It's the nature of people who are in the workplace or in schools to congregate and that's where the virus spreads."
In New York City, the Health Department places vaccine orders on behalf of health care providers who register and submit requests. These providers, which include schools, hospitals, health centers and employee health services, must agree to recognize priority groups in order to receive any vaccine.
"The Health Department does not distinguish between workplace and non-workplace vaccination settings," said Jennifer Scaperotti, spokesperson for the New York City Health Department. "As a result, it is not always possible to determine where a particular provider will vaccinate patients in a workplace, an internist's office or another setting. As long as the provider is adhering to the priority groups listed in the vaccine application, either is legitimate."
So far, New York City has received 98 percent of the 873,600 doses of H1N1 vaccine allotted to them by the CDC, of which the majority of doses have gone to pediatric facilities and hospitals. Adult providers, which include workplaces, have received 6 percent of all the available doses so far.