I’m conflicted on this question.

Usually, I get the shot at an allergist I’ve used over the years. Going into mid-October, he had not yet received any serum. Earlier in the week I called Tom Thumb, with Dylan they gave me the blues. They were out. Tom Thumb would not make an appointment until they got a new supply – anticipated on Friday.

I got my annual flue shot yesterday morning at a CVS clinic. The operation was good. The clinic was set from 10:00 a.m. until 2:00 p.m. I got there early, intending to read until 10:00. The provider got the ball rolling early. I filled out the insurance papers and got the shot at 9:50. The nurse told me to hang around the store for 10 minutes in case I had a reaction. I was out the door by 10:00. In all it was a rather pleasant experience. I have no complaints, only compliments.

I asked my nurse how they got serum when my doctor didn’t. She said it was a matter of “supply and demand.” Her organization had ordered 5,000,000 million shots, hence they got the serum before a doctor’s office that would order a smaller amount.

Today at the gym I use I asked a doctor I know how he thought flue shots should be distributed. He thought they should be distributed only through doctor’s offices. Note: This particular doctor is a plastic surgeon who has no vested interest in the question.

It seems like there will be no shortage of serum as in the pasts few years. It has occurred to me that the clinics might be beneficial in that they relieve congestion in doctors’ offices.

Still I have nagging doubts and questions.

Questions for debate:

1. Should “supply and demand” dictate flu vaccine distribution?

2. What do you think is the safest and most efficient method of distributing flu vaccine to end-users?

3. Does the distribution paradigm change in years when there is a shortage of serum and preference is given to health care workers, the elderly, people susceptible to respiratory infections, etc.?

For those interested, I am providing a link to CDC information on flu, including the distribution network.

http://www.cdc.gov/flu/professionals/bulle...tin3_100206.htm

This is an important issue. It is sometimes, literally, a matter of life and death.

The great challenge of the influenza vaccine distribution system is the fact that manufacturers have to start from scratch every year. It will never be easy.

Here's some more information from the CDC:

Link

It claims that large purchasers (drug stores and the like) do not have an advantage over small purchasers (private physicians and so on.)



(Bold added for emphasis)

1. If we assume that what the CDC says is correct, it would seem that "supply and demand" does not determine who will get the vaccine more quickly. However, it's obvious that a giant chain of drug stores is likely to have a larger, and possibly more effective, wholesaler than a small medical office. I don't think it's the result of any unfairness on the part of anyone, but just the nature of the wholesale distribution system.

2. I would suggest that the influenza vaccine be distributed in as many ways as possible. Although it may seem safer to restrict it to medical offices, the problem is that many people, particularly those with limited wealth and income, rarely, if ever, see a physician. As long as properly trained health care workers administer the vaccine, I see no reason why it could not be given in drug stores, public health clinics, community centers, and so on.

3. Problems with manufacturing the influenza vaccine cannot be predicted. When bad luck occurs, it is likely to have the biggest impact on those who rely on small wholesalers who carry only one manufacturer's product. Although there is no perfect way to deal with this problem, the ability to substitute a vaccine from another manufacturer is of great benefit.

Getting the vaccine to those who really need it, when there is a shortage, is a problem. From the same source:



(In other words, it is difficult to determine which providers should have the first chance at getting the vaccine from a limited supply.)



(Drug stores are at least as likely to see critical patients as medical offices.)

So what is the best strategy? It seems to me that there should be as many different manufacturers for the vaccine as possible. (Obviously, quality control cannot be compromised.) Tax breaks for the companies that manufacture it might help. The vaccine should be available in as many places as possible, as long as the conditions are safe. Providers should be both private and public. The cost to the patient should be minimal. Those with little or no ability to pay should not be locked out of the system.