This year, like every year, I see the same thing happen at the hospitals where I work. There is a huge demand for the annual influenza vaccine, and the supply of it quickly runs out. This year, we actually had some influenza vaccine stolen from an outpatient department.

It seems to me that this problem could be reduced if the vaccine could be better targeted at the population most at risk for serious consequences. For the typical, healthy, young or middle-aged adult, influenza will make them feel miserable, but they will not require hospitalization. For people with compromised immune systems, or for the elderly, influenza can lead to serious consequences, and may be fatal.

To be debated: Should there be some system for supplying the influenza vaccine to those most in need? If so, any suggestions? Or is the current "first come, first serve" system which is usually in place as good as any other system?

On a related issue: The influenza vaccine is usually offered to health care workers as soon as it is available at their place of work. Is this a good idea, since they come into contact with so many patients at risk of infection, or does this contribute to the problem of running out of the vaccine?

Well, how would we decide that all of the elderly and young that are going to get the shot have recieved it? Or do you suggest that everyone between the ages of 10-50 not get the shot at all? I say quarintine all those who catch the flu like it was SARS and blame it on homeland defense or something. Don't the two have similar symptoms anyway?

I don't have a good answer, which is why I ask the question.

I guess I would suggest that there be advertising that states something like "If you are over such-and-such an age, or have such-and-such a disorder, we strongly advise you to get the influenza vaccine." Maybe a price break -- free to persons over a certain age, etc.?

One idea that I've heard would be to target innoculations to so-called "superspreaders" who are likely to pass the disease on to a great many others. Here's one story about the idea, but I'm sure I saw something else on one of my daily sites about a quicker way to determine who those people are.

Edit: found it! By way of GeekPress, it's an article describing a very simple method:

QUOTE

The idea is to randomly choose, say, 20% of the individuals and ask them to name one acquaintance; then vaccinate those acquaintances. Potential super-spreaders have such a large number of acquaintances that they are very likely to be named at least once, the researchers found.

As a sometime researcher in network theory, I'd have to say the approach is brilliant in its simplicity.

I don't think it would work because most of the people in the Superspreader category are going to be the same people in the 6-60 category who have a good chance of fighting it if they do contract the virus. Infants and the elderly usually associate with a limited amount of people, and if they were to contract the virus they wouldn't be able to pull through as someone in their prime years.

All that is true, but that's not how targeting superspreaders works. The idea is that vaccinating one superspreader is as good as vaccinating hundreds of those isolated "leaf nodes" which are less connected but still not totally isolated. It's the whole "six degrees of separation" thing. Another way to look at it is by parallel to the internet. Even your machine at home is not too many links away from the big routers at the internet's core. If those big routers could somehow block viruses and worms without melting down under the load of scanning every packet, those nasties would never even get to you. Similarly, if the chain of biological infection is cut at the majority of superspreaders, very many people would never even be exposed to the flu virus and wouldn't need to be vaccinated themselves.

One dose, hundreds or thousands of people protected. No, it's not perfect, but neither are any known alternatives. You could combine this approach with targeted vaccination of those most likely to develop serious complications and you'd probably be doing a lot better than today.

Interesting articles, Plat.

I see some limitations to the application when it comes to the influenza, though. First, I'm not certain as to how much of the vaccine is available. It sounds as though the 20 percent-random plus acquaintances would exhaust a lot of the supply before most of the immunocompromised individuals could receive theirs.

Another problem is the minimal effectiveness of the vaccine. If memory serves, in the past couple of years the reduction in illness rates for the immunized was around fifty percent (around thirty for the immunocompromised and 70 for the healthy). Those individuals treated are not necessarily immune, but less symptomatic. I would expect that the super-spreader immunized child could potentially be well enough to go to out in public, thanks to the added resistance of the vaccine, but still a sniffly infectious carrier.

I lean towards the idea of immunizing the super-spreaders in cases of limited vaccine supply and effective vaccinations, but I'm not as certain with respect to a limited supply of marginally effective vaccinations. I think the best option would be to immunize the most susceptible in this case. Obviously, mass quarantine for anyone with a sniffle isn't a realistic option either.

This seems to me to be another flaw in the medical market. There is not proper incentive for the production of enough flu vaccines. If we run out every year, something, somewhere must be controlling the supply.

In free market conditions supply meets demand. Something is clogging it up.

That was my first response when I saw the debate question. Why is there never enough vaccine? Is there some kind of exclusivity on how it is manufactured? Is it manufactured in small amounts in order to keep up demand?

If there is no way to create enough of the vaccine for everyone, it does seem as if the high-risk individuals as well as the healthcare professionals should get it first. We shouldn't exclude the healthcare workers since they are the last line of defense once people start getting hospitalized for the flu.

According to a news segment I watched this evening, it's guesstamation (sp?). Last year the manufacturers made (if I remember correctly) 95 million doses and had 15 million unused doses left over which, according to the drug manufacturer, cost them millions. So this year they looked at how much they made last year, figured in their projections for this year and made 85 million. It wasn’t enough.

I am sitting here now wishing I had received the vaccine. I am one sick puppy.