Too Much Medicine

Last year at this time, Dr. James Nordin had run out of flu vaccines. This year, the Health Partners Medical Group in St. Paul, Minn., where Nordin is a pediatrician has 3,000 unused doses that are headed to the Dumpster if more patients don't take them.

And Minnesota isn't the only place overstocked with the shots. Though the flu season has yet to hit many parts of the country, doctors at several clinics in the U.S. are struggling to get people to take the vaccine.

"Once Christmas comes, people no longer think about flu shots," says Nordin.

Public health officials say that a delay in production, problems in the distribution system and good old fashioned psychology are to blame for the excess vaccines. And if the problems persist, it could mean a shortage of vaccines next winter.

Serious Problems

The flu shot isn't your typical vaccine. Its formula is changed every year by officials who try to predict which strain of the virus will hit next, and its distribution is handled mainly by private companies who earn comparatively low profits for their efforts. And each year, the Center for Disease Control releases recommendations for which segments of the population should take the shot.

All these moving variables make finding the balance between surplus and shortage each year very difficult. And the problem is serious: an estimated 36,000 Americans die every year from the flu, and 200,000 are hospitalized.

Two years ago, a flu shot shortage caused Sen. John Kerry to comment during his presidential campaign that he would not be taking the shot, leaving one of the only 54 million U.S. doses available for someone else more at-risk. This year, almost twice the numbers of shots are available, and doctors are having trouble even giving them away.

And because the flu shot costs clinics $11 to $20 per dose, that could mean big financial losses nationwide.

The surplus problem started last fall, when production of the flu vaccine was delayed by a month due to sterilization issues with some manufacturers. Because most people who get flu shots do so in the early fall, many patients were turned away from their clinics.

"Everybody comes in September [to get the shot]" says Dr. Mark Siegel, a New York University doctor who writes often on flu issues. Siegel had to turn away several patients because he didn't have the vaccine in the early fall.

Matthew Rowan, the President and CEO of the Health Industry Distributors Association, said flu vaccine distributors got calls from doctors wondering when the vaccine would come in.

"Anything that would help manufacturers safely produce vaccine in a more timely way is important," Rowan tells The vaccine is currently produced using 11-day old fertilized chicken eggs as incubators; a process experts agree is too time-consuming and costly. But the government has recently begun supporting new cell-based technology -- in which the vaccine is made in the cells extracted from caterpillar ovaries -- that scientists hope will produce the vaccine more quickly, and cheaply.

"We think that's a good thing," Rowan says.

But it wasn't just a late production cycle that caused excess flu shots this year. After the flu season last year, the CDC widened its recommendations on who should be vaccinated -- chief among them was the that all children under five should get the shot. This season, manufacturers distributed a record 102 million doses, according to government estimates.

"That's 20 million more than we've ever had," says Christine Pearson, a spokesperson for the CDC. She added that at the national level, the CDC does run such campaigns as "National Influenza Vaccination Week."

"There's a lot of work that goes every year into getting people to take the shots," says Pearson.

Siegel believes that the problems of distribution could be solved if the government exercised more direct control over the flu shot, buying more doses and taking a bigger hand in distribution.

"The problem with flu shots is that it's not a profitable business," Siegel explains. "The last thing [drug companies] want is to have a bunch of surplus." Siegel says that means that if there's a surplus this year; the market might correct and produce fewer vaccines next year.

That leaves it up to local clinics to market the extra doses to their patients -- a problem made difficult by public psychology about the flu shot.

Shot Psychology

Despite the market challenges of the flu shot, good old fashioned psychology also plays a big role in how many people get the shot.

"The warm weather had probably got a lot of people to stop thinking about the flu," says Siegal. While studies have shown that the flu virus lives better in the low-humidity conditions that come with cold winters, Siegal said that temperatures are dropping in the Northeast and Midwest -- regions of the country where flu season has yet to hit -- and that more people need to start getting the shot.

World events also have an effect. Nordin, the Minnesota doctor, remember that in 2003 there were many reports in the media of flu deaths happening in the Southwest, causing and increased demand for the shots. But then an event took place that almost completely halted his patients' demand for the shot: the capture of Sadaam Hussein.

"People have a short attention span," says Nordin. He agrees that clinics need to do a better job of marketing the vaccine to patients, as public psychology hasn't caught up yet to the increased CDC recommendations. He hopes that changes soon.

"The vaccine doesn't do any good sitting on a shelf."