Photo: A Centers for Disease Control and Prevention microbiologist reveals an egg’s contents through a translucent shell. This procedure allows microbiologists to determine the viability of eggs used in the isolation of influenza virus.

The lack of H1N1 vaccines is causing some localities to halt or postpone mass vaccination clinics, and even close their emergency operations centers (EOC) that were opened to organize events to vaccinate their at-risk populations. U.S. Health and Human Services Secretary Kathleen Sebelius said 69 million H1N1 vaccine doses are available or have been administered, but the federal government’s goal was to have 160 million people vaccinated by the first week of December. Sebelius told a meeting of the American Medical Association that technology is one of the impediments to creating new vaccines.

“We were fighting the 2009 H1N1 flu with vaccine technology from the 1950s,” she said. “We could race to begin vaccine production, but there was nothing we could do if vaccine grew slowly in eggs. We could make deals with foreign vaccine producers ahead of time, but we still wouldn’t have as much control over the vaccine as if they were based in the U.S.”
 

H1N1 at the Local Level

Cities and counties nationwide are trying to vaccinate their at-risk populations — which include pregnant women, people between the ages of 6 months and 24 years old, and people with chronic health disorders or compromised immune systems — but the lack of vaccines is making that task difficult. Washington County, Ore., recently closed its EOC that was opened to plan and coordinate mass vaccination clinics. According to Scott Porter, director of the county’s Office of Consolidated Emergency Management, nine mass vaccination clinics were completed during a two-week period.

Porter said there were two main reasons why the EOC was shut down:

• the county wasn’t receiving enough vaccines to keep up with the clinics’ demands; and
• the vaccines weren’t being administered to the people who were most at risk.
   

“We decided that doing these mass vaccination clinics where all priority groups were invited was not the best way to get to those people with chronic medical conditions,” he said. “So we decided to stop doing those clinics and move the vaccines to health-care providers who know who their patients are with chronic medical conditions.”

Porter added that this was a position the state took that the county agreed with. Although the Centers for Disease Control and Prevention identified the at-risk populations, the information didn’t match data that showed who was being hospitalized and who was dying from H1N1. “It became clear that there were some populations within those priority groups who were suffering at a much higher rate than the rest of the priority groups,” he said. “And those were primarily people who have chronic medical conditions and also pregnant women.”

Other localities also are changing vaccination plans due the lack of vaccine. Crawford County, Ark., postponed its mass vaccination clinic that was scheduled for Thursday, according to the Press Argus-Courier. A county health administrator told the newspaper the county is waiting until it has an adequate supply of both H1N1 and seasonal vaccines.

Going Viral

Sebelius told the American Medical Association meeting that the federal government has talked about updating vaccine technology for years. She said action is being taken and in late November a cell-based vaccination clinic was opened in North Carolina with support from the U.S. Health and Human Services Department.

“When this plant is up and running in 2011, it will be able to produce vaccine for a significant share of our population within six months of the onset of a pandemic,” Sebelius said. “What’s even more important is that this process will end our reliance on egg-based technology. That will allow the plant to produce vaccine faster and with no danger of egg-based allergies.”

The Health and Human Services Department also will review how its policies affect vaccine development and production, and strengthen its surveillance capability to prepare for future public health threats.

[Photo courtesy of James Gathany/CDC.]