Wall Street Journal - May 15, 2002
Andrea Petersen, Staff Reporter Of The Wall Street Journal

The current vaccine shortage is alarming parents and pediatricians who fear children are going unprotected for preventable diseases. But the crisis is worrisome for adults too.

Shots and the illnesses they prevent may seem like kids' stuff, but such diseases are far more lethal for grown-ups. Even before the present shortage, many adults weren't getting recommended shots. About 40,000 adults die each year as a result, according to the Centers for Disease Control and Prevention. By contrast, an estimated 100 children die annually from diseases that vaccines can prevent.

"This is an undeclared national crisis," says Greg Poland, professor of medicine and infectious diseases at Mayo Medical School in Rochester, Minn. "People panicked over five anthrax deaths, but 40,000 people dying is like a small hydrogen bomb every year."

Adults needing tetanus-diphtheria boosters -- which they should get every 10 years -- will probably have to wait until the end of this year. Vaccines to prevent measles and chicken pox, to which some adults are still vulnerable, won't be back to normal supply levels until mid-summer.

While the CDC says there's no nationwide shortage of the pneumococcal vaccine, which protects against some types of pneumonia and meningitis, some doctors have been having difficulty obtaining it. There has been a shortage of flu shots for the past two years, but the CDC expects supplies to be sufficient this winter.

The vaccine shortage is the result of a confluence of events, including production snafus and the abandonment of production by a few vaccine manufacturers. But even when vaccines are in ample supply, a big chunk of adults who need immunizations aren't getting them. With the pressures of managed care shrinking many doctors' appointments to 10-minute drive-bys, immunizations often are ignored. "Between mammograms, blood-pressure checks, colon-cancer screenings, you can see how a discussion about immunization can get lost in a visit to an internist," says Kathleen Neuzil of the American College of Physicians, a group that is in the midst of a three-year campaign to educate internists about adult immunization.

Also, doctors have a financial disincentive to give shots. Reimbursement levels from private insurance companies and Medicare often don't cover the cost of delivering a vaccine.

The problem is acute for all adults, not just people without access to good medical care. Even people who received all the recommended shots when they were children aren't protected from every vaccine-preventable disease. Recommendations change frequently as new science develops. And some vaccine-preventable illnesses, such as influenza and pneumococcal are more deadly for adults. The flu kills more than 20,000 people every year, most of them over age 65. But only about 65% of adults over age 65 get annual flu shots. And only 10% of adults under 50 who should get a pneumococcal vaccine because of a high-risk condition (including chronic lung or heart disease or diabetes) actually receive the shot. The disease kills about 7,000 people each year.

"The big issue is the perceived lack of vulnerability and the perceived lack of efficacy [of vaccines] by some of the public," says Walter Orenstein, chief of immunizations at the CDC.

Stu Ginsburg, a 57-year-old father of three, hasn't had an immunization in 30 years. His doctor usually offers him the flu vaccine during his yearly physical, but doesn't encourage Mr. Ginsburg to get it. "My mother gets a flu shot but she's 82," says Mr. Ginsburg, a senior vice president of Fava Entertainment, a television production and public relations firm in New York. Of the CDC recommendation that all adults over age 50 get the flu vaccine, he says: "I haven't heard about it."

Ceasing Production

Wyeth-Ayerst Laboratories made about one-quarter of all the tetanus-diphtheria vaccines in the U.S. But in January 2001, the company stopped making the shot. The sole remaining U.S. manufacturer of the vaccine, Aventis Pasteur, is boosting production and says it will be able to meet demand by the end of the summer. Last summer, Merck & Co. halted production at its vaccine manufacturing plant in West Point, Pa., to make some upgrades to the facility, leading to shortages and delays of vaccines to ward off measles, mumps and rubella and chicken pox.

A small but vocal anti-vaccine movement has directed attention to rare adverse side effects leading some patients to think twice about vaccination. For example, reports of bad reactions helped sound the death knell for a new vaccine against Lyme disease, a tick-borne illness that causes joint pain and fever. GlaxoSmithKline PLC pulled its Lymerix vaccine off the market in February after demand plummeted to an expected 10,000 doses this year from 1.5 million doses in 1999, the first year it was on the market.

Vaccine recommendations change frequently. In 2000, the CDC instituted its recommendation that all adults over age 50 should be get flu shots (the prior recommendation was for people over 65), since research showed that even older Baby Boomers could get severe complications from the flu.

Shots protecting against hepatitis B -- a contagious virus that can lead to liver cancer and causes about 5,000 deaths every year -- were initially recommended for only a small high-risk population, including intravenous drug users and men who have sex with men. Now the CDC recommends that all infants and adolescents get the three-shot regimen needed for immunity.

Since one-third of all those infected with hepatitis B have no obvious risk factors, some doctors are advising all of their adult patients to get the vaccine as well.

Other Recommendations

Doctors suggest women who may become pregnant get their rubella immunity checked since an infection during pregnancy can be devastating to a fetus.

College students and some international travelers are advised to get a second measles shot, since people born before 1989 only got one dose, which may not be sufficient. Measles and chicken pox are much more dangerous for adults than children.

New vaccines -- and likely new recommendations -- are on the horizon. Clinical trials are under way of a vaccine to prevent human papilloma virus, a sexually-transmitted disease that is responsible for almost all cervical cancers. Researchers are studying whether a dose of chicken pox vaccine may prevent shingles infection, an illness characterized by a painful rash that primarily afflicts the elderly. Fears of bioterrorism are spurring discussion of whether Americans should be vaccinated against smallpox. And, there is a flurry of work on the Holy Grail of vaccines -- one that would protect against HIV.