Avoiding Flu Vaccine Shortages for Hospital Staff

Author: James C. McAllister III, MS, FASHP, Pharmacy Times Editor, Health-Systems Pharmacy Section

Periodic shortages in drug supplies plague all pharmacists and, if I do say so, pharmacists perform an admirable job of implementing strategies to cope with these shortages while optimizing patient outcomes. It often requires extra work for many pharmacists and their staffs, but their efforts are accomplished collaboratively with medical staff members and remain transparent to patients.

On the other hand, the flu vaccine shortage of 2004 was a very public phenomenon. It was worsened by media hype, which created fear and limited availability of the vaccine to high-risk groups.

Last year, my hospital appointed an advisory group composed of pharmacists, infectious disease physicians, and representatives from epidemiology, infection control, and hospital administration departments, to develop and implement a program to control vaccine distribution. The purpose was to prioritize immunization based on scientific data and guidelines imposed by federal and state agencies.

In retrospect, I can say that this approach was appropriate, but it was not efficient or convenient and probably was not effective. The hospital decided to give patients the highest priority and severely restricted immunizations to direct patient caregivers. Whereas decentralized clinical pharmacists and retail pharmacists were included in the high-priority group, technicians, central-pharmacy-based staff, and others without direct patient contact were placed at a much lower priority level.

By the time the last shipment arrived, the hype had abated, the incidence of infected patients was only average, and patients (including health care workers) who had been denied vaccinations earlier apparently decided to forgo immunization. At the end of the flu season, the hospital had thousands of unused doses of vaccine in its inventory.

This year, the hospital has taken a different approach while complying with recommendations from the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices. All health care workers will be eligible for vaccine as a top priority, along with highrisk patients, on a "first-come, first-served" basis. We are encouraging most health care workers (except those who care for severely immunocompromised patients) to consider using the nasal form of the vaccine. We are attempting to educate hospital staff members about making informed decisions regarding immunization.

I suspect that most hospitals and their pharmacies develop similar strategies. Yet, do they make sure that the entire staff understands the strategies and goals? Are they proactive in working with the media to dispel myths, allay fears, and encourage optimal utilization? Do they effectively partner with nearby hospitals and community pharmacy colleagues to optimize patient outcomes? I wonder.

Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.