2009 H1N1 Influenza -- Just the Facts: Vaccine Essentials

John G. Bartlett, MD


November 23, 2009

In This Article

Vaccine Supply, Purchase, and Payment

The US government ordered 250 million doses of pandemic influenza vaccine at a cost of $2 billion. (Stein R. First swine flu vaccine arriving in cities. Washington Post. October 6, 2009.) The first vaccine to be supplied in the United States is FluMIST®, the LAIV that is limited to persons aged 2-49 years who do not have chronic disease and do not have close contact with persons with severe immunodeficiency. (Neergaard L. First swine flu vaccine on the way, still limited. Associated Press. October 2, 2009.) This vaccine may be given at the same time as other injectable vaccines, such as seasonal vaccine or Pneumovax®, with a 3- to 4-week delay between dosing with seasonal LAIV (FluMIST® for seasonal flu) and FluMIST® for pandemic flu. Pandemic flu vaccines (inhaled LAIVs and injectable killed virus vaccine) are provided by the government, but there may be an administrative charge of about $20. (Neergaard L. Q & A about vaccines for swine flu, regular flu. Associated Press. October 6, 2009.)

Purchase and Payment

The government will buy the vaccine supply along with needles, syringes, and alcohol swabs, and provide these items without cost to states according to population. State health departments and some local health departments will be responsible for vaccine distribution. Many will partner with the private sector to ensure efficient and rapid distribution. Presumably, the vaccine will be provided without charge in the public sector, but in the private sector there may be a separate charge for administration; third parties are vague about reimbursement.

Vaccine Supply Update

Vaccine supply data. The number of 2009 H1N1 flu vaccine doses allocated are posted daily at noon Eastern time at https://www.cdc.gov/h1n1flu/vaccination/vaccinesupply.htm

Vaccine availability. At a press briefing on October 23, 2009, CDC Director Tom Frieden stated that in regard to vaccine production, "We are nowhere near where we thought we'd be by now." The technology of vaccine production is not well suited to pandemics because the standard planning anticipates a 6- to 9-month period between emergence of a new virus and a vaccine supply. Frieden also stated:

  • If a high-risk patient thinks that he or she has H1N1 flu, he or she should still get vaccinated because many people have had other viral infections that were mistaken for H1N1.

  • Pregnancy represents a major risk with a 6-fold increase in mortality. The vaccine is a high priority for pregnant women. Thimerosal-free vaccine is often preferred by patients, but there is no evidence of risk related to thimerosal-containing vaccine.

(CDC. Online Newsroom. Weekly H1N1 flu media briefing, October 23, 2009. Available at: https://www.cdc.gov/media/transcripts/2009/t091023.htm Accessed October 27, 2009.)

Vaccine shortage for children needing a second dose. (Rubin R. Vaccine shortfall has parents waiting for H1N1 booster. USA Today. November 11, 2009. Available at: https://www.usatoday.com/news/health/2009-11-11-swineflubooster11_ST_N.htm Accessed November 13, 2009.)

The vaccine has been available for 5 weeks for some, but the supply is still inadequate and children ages 6 months to 9 years who need 2 doses are experiencing difficulty getting the second dose. Dr. Fauci is quoted as saying that a single dose in the designated age group is useful, but the antigenic response in this age group also means that the second dose is important. He also noted that waiting 5-6 weeks "is fine." The need for the second dose in this age group appears to differ in Canada and Europe where adjuvanted vaccines are used.

Where to get seasonal and 2009 H1N1 influenza vaccines. The CDC maintains a Website that provides extensive information about 2009 H1N1 influenza for the provider and patient, including state-specific news. The American Lung Association (ALA) also has a Flu Clinic Locator. The Flu Clinic Locator has a mechanism for a provider to add to the clinic listing and for the patient/consumer to find a clinic. The ALA's flu clinic directory, which was established in 2003, has over 43,000 clinic sites that can be searched by zip code. The listing provides addresses, telephone numbers, hours of operation, distance from the zip code, and a map for each clinic site.

State discrepancies in flu vaccination sites. All states have received 2009 H1N1 influenza vaccine for distribution, but there is great variation between states in Web-based information on vaccination sites for consumers. New Jersey, Wisconsin, and Kansas are cited as exemplary states for Web-based information about where to get the H1N1 influenza vaccine. In contrast, Alabama and Mississippi are noted to have "virtually no specific information about where flu shots can be found." (Hutchison C. Best and worst states for h1n1 flu vaccine info. ABC News Online. October 27, 2009. Available at: https://abcnews.go.com/Health/SwineFluNews/best-worst-states-h1n1-vaccine-info/story?id=8921708 Accessed November 3, 2009.)

Poll of Americans Unable to Get H1N1 Vaccine

A poll from the Harvard School of Public Health interviewed adults who tried to get the H1N1 vaccine for themselves or their children but were unable to do so. The interviews were conducted from October 30 to November 1, 2009 and included 1073 respondents 18 years of age or older who were representative of the US population. The 95% CI is +/- 3.8%. Results:

  • Respondents who believe the vaccine shortage is now a serious problem: 47%

  • Respondents who believe the vaccine shortage will be a serious problem for themselves or their family if the vaccine is not available until December: 52%

  • Respondents who have tried to obtain information about the availability of the pandemic H1N1 vaccine: 33% (for self: 16%; for someone else: 17%)

  • In a subset analysis of 33% (n = 345) who have tried to get this information, 51% found a vaccine location

  • Number who received vaccine themselves: 45; for their children: 44

(Harvard School of Public Health. Press Release. Poll finds two-thirds of parents and high-priority adults who tried to get H1N1 vaccine were unable to get it. November 6, 2009. Available at: https://www.hsph.harvard.edu/news/press-releases/2009-releases/ Accessed November 10, 2009.)


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