Nov. 5, 2009 -- 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.
In addition to Goldman-Sachs, other non-medical businesses receiving vaccine in New York City included Citigroup, the Federal Reserve Bank and Time. And leading hospitals in the city have gotten vaccine including New York Presbyterian, St. Vincent's, NYU, Memorial Sloan-Kettering, Montefiore, Mount Sinai, North Shore and Continuum. Continuum reported receiving 8,100 doses out of 48,600 ordered.
Balancing Those Who Need Vaccine
Poland pointed out that it was important to strike a balance between vaccinating priority groups and the general population, and that while doling out vaccine on a rolling schedule is the best way to vaccinate the greatest number of people, the practice can be frustrating for some.
"When [a person] gets immunized, then the child in our family who can't take the vaccine is protected," Poland said. "Our coworker has some degree of protection, as does the person we stand next to in the elevator. You want to get as many people immunized as quickly as possible."
Ethics Watchdog Group Incensed By CDC's Actions
Still, the fact that some businesses appear to be getting the vaccine before some other groups has caused outrage among many doctors -- especially in light of reports that hospitals and health departments report that they are experiencing shortages of vaccine.
Dr. Albert Levy, a New York physician, told ABC News that he hasn't received "a single dose of the injectable [vaccine]" and that it is "rather frustrating to me and my patients and truly upsetting to hear that the Wall Street executives have found yet another way to take advantage of the rest of the community."
Dr. Lisa Thorn, a family physician in Averill Park, N.Y., says this "confirms what we have known for years ... even when it comes to medical care, people in high places consider themselves more valuable to society than everyone else."
"As we are still in the early weeks of the vaccine supply, we are by definition in a 'shortage' and do not have enough vaccine to meet the state's needs," says Seth Boffelli, a representative at the Wisconsin Department of Health.
Dr. Frank James, San Juan County Health Officer in Washington, said they "do not have adequate vaccine to prevent the spread of disease, as the vaccine ... continues to arrive too late for that goal to be practical."
Other hospitals throughout the country report receiving doses of the vaccine, but that the supplies they have been allotted are woefully inadequate.
CREW executive director Melanie Sloan alluded to this situation when she wrote a letter to Health and Human Services Secretary Kathleen Sebelius.
"Although CREW has been unable to uncover the demographic makeup of [these companies], surely it is safe to assume the vast majority of their employees are not pregnant women and children, young adults up to 24 years old, and healthcare workers," Sloan wrote. "Under these circumstances, it is the height of irresponsibility for the CDC to approve distribution of the vaccine to anywhere other than where it is most likely to be provided to those at the greatest risk."
But in a statement, Goldman Sachs said they intend to follow the CDC's vaccine guidelines. "It is important to understand that the Department of Health decides in its sole discretion who receives H1N1 vaccines -- both the amount and timing. Goldman Sachs, like other responsible employers, has requested vaccine and will supply it only to employees who qualify based on the requirements laid down by the CDC and Department of Health."
The ABC News Medical Unit's Radha Chitale, Roger Sergel, Courtney Hutchison and Dan Childs contributed to this report.