Low Vaccination Rates, Gaps In Flu Policies Contribute To Vaccine Shortages, Other Preparedness Problems

January 15, 2013
by Anthony Kimmery
Homeland Security Today

A new study of flu vaccination trends and policies by the Trust for America's Health (TFAH) found that fewer than half of Americans ages six months and older were vaccinated against the flu during the last two flu seasons (2010-11 and 2011-12).

“For the first time during the 2010-11 flu season, the Centers for Disease Control and Prevention (CDC) recommended that all Americans ages six months and older receive the flu vaccine,” the Washington, DC-based public health advocacy organization said Tuesday in announcing the results of its study. “The historically low demand for seasonal flu vaccinations has contributed to limiting the supply of vaccine manufactured each year.

"The flu is an annual threat,” and “some years, like this one, the threat is more severe than others,” TFAH Executive Director Dr. Jeffrey Levi said in a statement.

Levi said “The problem is we let our guard down during mild seasons and then we aren't ready when a harder season hits. We need to maintain a steady defense and make annual flu vaccinations -- and the manufacture of sufficient supply -- a much higher priority every year."

Every year, TFAH said, “around 20 percent of Americans get the flu,” and that “between 3,000 and 49,000 Americans die from flu-related illnesses and an average of 226,000 are hospitalized. The flu leads to economic losses of more than $10 billion in direct medical expenses and more than $16 billion in lost earnings.”

Public health officials and authorities have long been concerned about the low numbers of adults -- including health care workers -- who refuse to get vaccinated or who refuse to have their children vaccinated against influenza. Children are among the biggest conveyors of flu viruses. In recent weeks, hospitals with a mandatory vaccination policy for its employees have fired dozens of health care providers, including nurses, for refusing to be vaccinated.

TFAH reported that it has identified “additional actions that could be taken to fill persistent gaps in flu preparedness and policy, including:

Reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA) to address and update ongoing challenges in the ability of the public health system to respond to health threats and ensure targeted investment in flu-related medicines and technologies;
Ensuring all healthcare personnel receive the annual seasonal flu vaccine every year;
Educating the public, especially at-risk groups, front-line workers and clinicians about the seriousness of the flu, the need to be vaccinated and the safety of the vaccine;
Continuing investments in expanded domestic flu vaccine manufacturing capacity with government guarantees to industry to assure an adequate supply during bad flu seasons;
Improve diagnostics to ensure accurate surveillance and proper treatment of influenza-like illness;
Expanding the use of nurse triage lines and other pre-hospital systems to reduce the number of healthy people seeking medical care;
Covering flu vaccines under public and private insurance without cost-sharing. For instance, currently, 12 states and Washington, DC do not require Medicaid to cover flu shots with no co-payment requirements for beneficiaries under the age of 65;
Investing in research for a universal flu vaccine to replace the annual shot;
Sustaining investments, such as the Prevention Fund investments that have been used to improve the Immunization Information Systems and other information technologies, in immunization programs, adult immunization programs and vaccination capacity in schools;
Better integration of electronic health records and public health surveillance systems to improve surveillance of flu outbreaks and improve two-way communication between clinicians and public health experts;
Allowing workers in businesses with 15 or more employees to earn up to seven job-protected paid sick days each year to be used to recover from their own illnesses, access preventive care or provide care to a sick family member. Currently, around 38 percent of private workers do not have any sick leave coverage (around 40 million Americans); Maintain the Strategic National Stockpile with emergency medical equipment and vaccines and medicines not only to respond to new pandemics but to help respond to shortages;
Improving disaster surge capacity so hospitals and health care providers are better able to respond to major increases in numbers of patients, including through regional coordination, strengthened health care coalitions and planning for discharging non-emergency patients; and
Sustaining federal, state and local funding for core public health capabilities, to ensure there are adequate resources and staff to maintain ongoing functions and respond to emergency needs when they arise. Since 2008, state and local health departments have cut more than 45,700 jobs across the country.

As of November 2012, TFAH reported that according to data collected from CDC this season's flu vaccination rates were similar to those in 2011 (36.5 percent of Americans ages six months and older were vaccinated by November 2012 compared to 36.5 percent by November 2011).

According to data from CDC, vaccination rates have varied widely by state. TFAH found that “During last year's flu season (Fall 2011 to May 2012), vaccination rates of individuals ages six months and older ranged from a high of 51.1 percent in South Dakota, to a low of 32.6 percent in Nevada.” And 12 states had rates below 40 percent.

In addition:

Child (ages six months to 18 years) vaccination rates ranged from a high of 73.8 percent in Rhode Island to a low of 38.8 percent in Alaska. Twenty states had rates below 50 percent. Hispanic children were the most likely to be vaccinated at 59.5 percent, compared to 53.7 percent of Black children and 47.6 percent of white children;
Seniors’ (ages 65 and older) vaccination rates ranged from a high of 75.9 percent in Iowa to a low of 49.5 percent in Alaska; and
Among health care workers, 66.9 percent were vaccinated.

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