Time to Fix a Failed Distribution System
Good afternoon. I’m Dr. William Lander, a practicing family physician from Bryn Mawr and Immediate Past President of the Pennsylvania Medical Society. I’m here today to represent the Pennsylvania Medical Society.
Let me begin by thanking Chairman Baker and members of this committee for holding today’s hearing on the influenza vaccine and its distribution. The Pennsylvania Medical Society appreciates the opportunity to speak on the subject.
If our flu vaccine distribution system were in perfect working order, we wouldn’t be here today. I’m willing to bet that some of you likely heard from constituents who informed you that they had problems getting their annual flu shots. I promise you that the Pennsylvania Medical Society heard from both patients and physicians about problems associated with the vaccine’s distribution.
Before I get into details of the distribution problem, let me share my personal experience as a physician.
This past flu season, I did not receive any shipments from my vaccine supplier. Not one shot, despite having placed an order in a timely manner.
I got lucky in that a friend in a local hospital system knew that they may have additional supplies, and through the health system I was able to obtain enough vaccine for 100 patients. But that was it.
Similarly, the year before, I received nothing from my vaccine supplier.
During both years, some patients had to be referred to other locations for a shot. And in some cases the patient went without being vaccinated at all.
This past flu season, I believe we were lucky. The flu season started slowly, and never hit our typical peak. But, there’s no reason to expect that we’ll be as fortunate next season.
And, next season already worries me. The reason is I was one of the many doctors who tried to place an order for next year only to be told that vaccines from one supplier have already sold out, which makes me wonder who’s buying it.
I want to express my concern with the distribution process. Specifically, I’m concerned that the middleman is manipulating the system to obtain a high quantity of vaccine to sell to larger retail chains and outlets.
Now, I don’t want to dismiss the opportunity to hit mass populations through retail outlets. They do serve a purpose that helps many. However, the most vulnerable patients are those who are probably already working directly with their physicians. They have an established physician-patient relationship, and they trust that working relationship. Unfortunately, while supplies are sent to larger outlets, small operations such as private practice physician offices have difficulty receiving full orders. I’m an example of such a situation. However, the Pennsylvania Medical Society believes that the first available batches of the vaccine should be where proper triage can take place, and where patients at most risk can be taken care of.
With the threat of avian flu looming in background, the Pennsylvania Medical Society believes the country’s system of distributing flu vaccines deserves attention. Proper distribution channels should be developed and universally applied as future public health hazards may be much more dangerous.
During the past flu season, the Pennsylvania Medical Society received numerous phone calls from members in different parts of the state who indicated they were not receiving their supplies as ordered. We’ve noticed, based upon these calls, that there is no rationale for shortages based upon geography, but rather distribution problems exist based upon the size of the orders. Smaller practices were particularly ignored within the distribution system because their orders were smaller.
This past season our country had essentially two major firms distributing 73 million doses. I would note that, in 1999-2000, the United States had four major producers distributing 50 million doses.
This past year, it appears that while adequate supplies should have been available, the distribution system clearly demonstrated flaws in reaching high-risk populations. Distribution appears to have favored big purchasers, including large, public promotional vaccination events, instead of high-risk populations and the physicians who serve them.
The Pennsylvania Medical Society supports legislative and regulatory efforts to reform the vaccine production and distribution system. We propose that the federal government be allowed to control the system to the extent necessary to achieve two things: to maintain production at sufficient levels for the anticipated seasonal threat, and to facilitate distribution that assures first priority for persons at highest risk. The Medical Society also supports legal protection for manufacturers of vaccine that follow proper manufacturing practices and for health care personnel who provide or withhold vaccinations in accordance with CDC guidelines.
Better collaboration and cooperation among many different groups involved in influenza production and vaccination are necessary. A more effective program that prioritizes existing supplies for high-risk patients should be put in place.
I’ll conclude by mentioning that we’re suggesting a national solution, including reasonable legal protection for responsible manufacturers and health care personnel, as I just mentioned. But we shouldn’t ignore the ability of the states to leverage reform. The Commonwealth of Pennsylvania is a major purchaser of pharmaceuticals. As such, in addition to applying pressure to federal officials, the state may want to investigate creative ways through its strengths as a purchaser to solve this problem for Pennsylvania's most vulnerable patients.
On behalf of the Pennsylvania Medical Society, I thank you for the opportunity to present testimony today on this very important subject.
Last Updated: 7/31/2008