H1N1 Vaccine Delays Remind Us Why We Need a Sound Public Option

I must have had a premonition the other day when I wrote a blog about delays in H1N1 because my daughter is now in bed with a fever, aches, and the symptoms of flu. She had the seasonal flu shot weeks ago, so this may very well be H1N1. Her doctor says that as an otherwise healthy 17-year-old she is not in the group that should immediately begin an antiviral medication. She should drink liquids, stay warm, stay in bed, and take ibuprofen. And we should keep alert. But I'm worried, as any parent would be. Knowing we're in a "national emergency" and having seen how severely some children are affected, you can't exactly rest easy when your child has flu symptoms. So I bring her liquids and stay near as so many other parents are doing.

As a professor of both business and preventive medicine for years, I'm appalled at how long it is taking for the H1N1 vaccine to reach at least those at high risk. Does this mean I believe less in a public option for health care coverage? No. One is the result of misjudgment and likely some degree of negligence in working with manufacturers of the vaccine. The other is about making sure that people without health care coverage have an option so that they are not left out in the cold, suffering like my daughter, but with nowhere to turn.

If anything, the lateness of the H1N1 vaccine, actually the very existence of H1N1, tells us that we need a public option. As Jane Hamsher's blog indicates, the more we allow pharmaceuticals and insurance companies to dictate when, how and to whom needed medication will be dispersed at reasonable costs, the more people without sufficient monetary means will suffer. By contrast, the more pharmaceuticals have to worry about whether our government might make a deal with someone else and that they aren't running the whole show, the better off we'll be.

My daughter's illness reinforces my frustration about vaccine delays. But illness like hers also reinforces the need for options, the need for competition (which Republicans used to like) and a way for all of us to have access to medical care no matter where we are in the inevitable up and down cycles of life. In fact, it reinforces the need for more options, not less, so that vaccines will be safe.

Let me add, that I'm not opposed to pharmaceutical companies or insurance companies. They do what they do well at times and often save lives. Some of their research has helped people fight dreaded illnesses, in my case cancer and Parkinson's, and live longer than expected. But it is up to us to insist that that they do so in ways that assure, to the best of our ability, medical care of countless people whose lives could be at risk were we to leave such companies to their own devices. The banks have proven that point again and again.

Those in whose hands we place our health, as individuals and as a nation, need to know that people like Jane Hamsher are watching them. They need to know that there will be a public option and not just one that means victory on paper for a few on the Hill - not a sell-out - but one that assures, to the extent possible and without regard to wealth, survival of future H1N1 type illnesses and those we cannot as yet foresee.

Dr. Reardon also blogs at bardscove.

Comments

[Sheldon101]

I don't see this as a public versus private issue. It's partly a chicken shortage (according to Novartis) and that H1N1 doesn't grow as well in eggs as other flu strains do, so it takes more eggs to make the same amount of vaccine.

Until recently, there wasn't a lot of money in making vaccines, so the same small group of companies kept making vaccines that were sold mostly to government.

Things have changed as new vaccines such as Gardasil and the pneumonia vaccines are being priced for a good profit.

And along came avian flu. That scared governments enough to start funding private companies with guaranteed orders, plant expansion and purchasing stockpiles of prepandemic H5N1 vaccines.

Coming down the line are influenza vaccines that should be more effective and can be developed much faster. There's Baxter's UK flu vaccine. And some really neat ideas.

The limiting factor for better flu vaccine may be Jenny McCarthy and her ilk who make conventional flu vaccine hard enough for people to use--- let alone insect based vaccines.

[offred]

The vaccine is being manufactured by private pharmaceutical companies, which don't want to spend money on making vaccines that might not be used and therefore would not make them a profit.

Maybe the government should manufacture such vaccines in advance of anticipated needs; if the vaccines are not needed, then the government could absorb the loss or donate the vaccines to places that need them.

Making a vaccine takes approximately a month; you can't force it to be any sooner. For a good explanation of the timeline, see http://www.who.int/csr/disease/swineflu/notes/h1n1_vaccine_20090806/en/index.html.

"Producing each batch, or lot, of antigen takes approximately two weeks."
"Each batch is tested and the sterility of bulk antigen is verified. This process takes two weeks."

[jade7243]

Actually, that is after the strain of the virus has been identified, isolated and incubated. According to the FDA, that stage of the process can take months -- not weeks.

Influenza vaccines cannot be made in advance because the components of the virus are different every year as the virus mutates -- seasonal flu -- or is a new or re-emergent strain (H1N1 which also contains elements of bird flu). To be effective the vaccine must be developed from the virus circulating.

Because of differing approval processes in other countries, it is not always possible to donate or sell the vaccines not used here to other places. Perhaps better coordination is in order.

Unfortunately, this is a lack of production facilities, not lack of insurance. Through the public health service (which is a federal agency under the management of the Surgeon General) there could be more (and free) distribution clinics for the vaccines to provide greater access.

[NorthSide]

The other factor that happened this time was that the egg-based vaccine production process was making only 1.5 doses per egg, rather than the 3-4 doses of seasonal flu. The companies took some weeks to develop a strain that produces 3 doses reliably. Then the new production runs can begin, which adds 3 weeks onto the process before you get more product. You can't just buy more eggs and a heating pad and start cranking out more vaccine.