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Dr. Raymond Scalletar has watched with frustration in recent weeks as healthy, young people receive their flu shots, while frail, elderly patients go without.
"The problem is there is obviously a maldistribution of the vaccine going to supermarkets and employers giving it to healthy employees," said Scalletar, whose practice is in Washington, D.C. "On the front lines, we don't have it."
As flu season nears, physicians and companies that host immunization programs are dealing with a manufacturing problem that has delayed delivery of the shots.
Most high-risk patients would normally be vaccinated by late October, but this year only two-thirds of the 75 million shots will be distributed by December.
Manufacturers were caught by surprise last May when they realized one of the flu strains included in this year's vaccine would take longer to grow than usual.
Then in September, one of the producers responsible for 9 million doses closed its production plant. Another pharmaceutical company, Aventis Pasteur, will produce the order.
"No one here can remember a situation like this," said Len Lavenda, spokesman for Aventis Pasteur. "We think it is unlikely to repeat, but clearly this year is an aberration."
The Centers for Disease Control and Prevention encourage both healthy and sick people to receive flu shots annually. The agency estimates 20,000 Americans die from the flu each year, and 100,000 more are hospitalized.
CDC guidelines state older people and those with pre-existing health problems be given top priority. But despite the advice, no one can control who's actually getting the shots, said spokesman Chuck Fallis.
He stressed, however, that receiving a dose in December or later is still not too late to avoid getting sick, as the flu often doesn't strike until mid-winter.
"Even if the vaccine comes later, people should get vaccinated because it only takes two weeks to take effect," Fallis said.
To help matters, Aventis has asked its customers to comply with the CDC immunization guidelines.
"For the majority of people, influenza is an inconvenience. It's uncomfortable, it's annoying, but it's not life-threatening," Lavenda said. "But for high-risk individuals, it is life-threatening."
Although the elderly take precedence, employers are also concerned about keeping their workers healthy for personal and economic reasons.
Last year, General Motors vaccinated 100,000 employees, and plans to distribute the shot to at least that many in mid-November, said Robert Minton, GM's health-care spokesman.
The company has used internal communications to help make sure employees at the highest risk for the flu, including those with chronic illnesses, get the shots. But GM also hopes to avoid massive sick-outs at a crucial time.
"As you get towards the end of the year, you want to make sure that you're able to hit your production targets," Minton said. "But the bottom line is, we value the health of our workers, and we want to make sure they stay healthy.
Scalletar hopes that businesses with less-urgent needs will share their vaccine supplies until more becomes available. He also sees a lesson for how to handle distribution.
"I think in the future, the CDC and surgeon general should use any bully pulpit that they can" to make sure the neediest get immunized first, he said.
This year, Lavenda said, it's up to Good Samaritans. "For this to be successful requires the voluntary cooperation of everyone, from doctors and nurses to every citizen."