First, people were clamoring for H1N1 vaccines, but there were not enough supplies to go around. By the time vaccines were available in any quantity, most of the public had lost interest.
And no one knew just how unpredictable the production of vaccines would turn out to be, top U.S. public health leaders agreed in a comprehensive review of the swine flu panic late last week.
Getting ordinary citizens to roll up their sleeves and get vaccinated was definitely one of the biggest challenges to managing the pandemic of H1N1 swine flu, speaker after speaker agreed at a conference looking at shortcomings in the flu policy response.
“The truth is, for this pandemic we had about the longest warning we might ever have for a potential biothreat,” said Dr. Nicole Lurie, who heads preparedness at the Department of Health and Human Services.
“And yet we all lament how long it took for vaccine to be made,” she told the conference, sponsored by the Center for Biosecurity at the University of Pittsburgh Medical School.
The Atlanta-based Centers for Disease Control and Prevention (CDC) estimates H1N1 has killed about 12,000 Americans, and possibly as many as 17,000. It put another 250,000 people into the hospital.
When the flu outbreak was first detected last April, officials got flu manufacturers working on a vaccine within weeks, and the CDC said more than half the U.S. population should be vaccinated quickly. Health and Human Services Secretary Kathleen Sebelius said 250 million vaccines had been ordered and any American who wanted to be vaccinated would be able to get a flu shot.
But it didn’t happen.
“We told people to prepare to be vaccinated in October, and then we didn’t show up with vaccine,” said Dr. David Lakey, Texas health commissioner.
First, vaccine makers had trouble growing the virus. Then there were problems getting vaccines into vials and shipped. And, experts told the meeting, other problems kept popping up.
The CDC says that by Feb. 13, as the pandemic waned in the United States, only 97 million H1N1 vaccine doses had been given to 86 million people in the United States - or 78 percent of doses shipped.
“The most vaccine we ever shipped in one week was 16 million doses,” the CDC’s Dr. Anne Schuchat told the meeting. Initial predictions had been for 20 million a week.
“All the vaccine in the world is not going to work if you can’t deliver it,” CDC Director Dr. Thomas Frieden said.
Maryland state Health Secretary John Colmers bemoaned the initial rosy predictions about vaccine supply.
“It had a profound effect on our ability to plan,” he said. “Supply didn’t equal demand. We had a lot of demand, not a lot of vaccine, and then we had a lot of vaccine and not much demand.”
In yet another complication, the U.S. government relied on five different suppliers, each of whom made vaccine in a slightly different way. MedImmune’s nasal spray, for example, was well-suited for children but inappropriate for high-risk adults and some of the shots were not recommended for young children.
The CDC and the Department of Health and Human Services had to patch together an ad hoc network of private manufacturers, a private distributor and numerous retail clinics, hospitals, doctor’s offices, employers, state and city health departments.
Ordinary citizens were then on their own to decide if and when to get vaccinated.
“Our colleagues in [Britain] said no problem - [they] just tapped into the electronic health records,” Dr. Frieden said. They were able to identify patients with high-risk conditions and invite them to come in and be vaccinated by appointment.
And then there were the rumors the vaccine was not safe.
“We can’t ever be in a situation again where we have a counter-measure that half the public won’t accept,” Dr. Lurie said.
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