After weeks of campaigning to limit flu vaccinations to the people most in need, the nation's top public health agency announced a new problem yesterday: Not enough of those urged to receive the vaccine are even trying to find it.
"We want people in the high-priority group to seek vaccination," Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention in Atlanta, said during an afternoon conference call.
"Many people believe that no vaccine is available and ... that is just not the case."
Nationwide, just over a third of adults in the high-priority category - including people with chronic health conditions, those 65 or older and health-care workers - said they received the vaccine this year, according to the results of a survey released yesterday. That compares with 54 percent last year.
But just half of those 65 and older even attempted to get a flu shot, a separate survey found. Among people with chronic illness - such as heart and lung conditions, diabetes or asthma - only 37 percent tried.
Some, Gerberding suggested, were likely deterred by long lines snaking through supermarkets and other flu shot clinic locales after the announcement that nearly half the nation's vaccine supply would be kept off the market because of manufacturing problems.
Some elderly patients erroneously believed that the influenza vaccine somehow causes the illness it is designed to prevent, she said. Others assumed they didn't need the vaccine or that, because of the scarce supply, none would be available.
No matter their reason for shunning the shots, the message from health officials - at least to those on the A-list - was clear. "It's not too late to get the flu vaccine," Gerberding said. "And we want people stepping up to the plate."
Health officials in more than 80 percent of the states have told the CDC they have a sufficient quantity of vaccine to meet the public's demand. Some states have even begun lifting restrictions on who is eligible for immunization.
But Gerberding frowned on that notion yesterday, saying health officials who believe they have "surplus" doses should return them so they can be sent to states without enough.
"Our goal is just common sense," she said.
The CDC will hold onto more than a million doses of a foreign vaccine manufactured by GlaxoSmithKline - which the government purchased this month on an emergency basis - until all the licensed vaccine has been used up.
Although it is used widely around the world and regarded as safe and effective, the Glaxo vaccine has not been approved by the Food and Drug Administration for use here.
It is unclear whether some of those doses will ultimately go unused if more people don't seek immunization and there is a relatively mild flu season - which seems to be the case so far.
The federal Advisory Committee on Immunization Practices, which recommends who should be vaccinated, is planning to convene today to consider relaxing the restrictions it imposed when the shortage first came to light.
Even if the extra vaccine winds up going to waste, Gerberding said, the government's decision to purchase it should be viewed as a necessary "investment."
Greg Reed, program manager for the Maryland Center for Immunization, said that this year's statewide vaccination rate for high-priority adults is 35 percent, unchanged from last year, according to a state-by-state telephone survey conducted by the CDC this month.
Maryland's state and local health departments received about 120,000 doses of vaccine for use in the public sector. A redistribution plan overseen by federal health officials provided an additional 96,000 to the Maryland Department of Health and Mental Hygiene for hospitals, nursing homes and physicians in private practice. Of that vaccine, roughly 16,000 doses are still available.
"You're seeing a lot of people doing what you call self-deferring. They are eligible - they fall within the [high-priority] category, primarily by age - but they are deferring to people who are sicker," said Reed. "We are continuing to put out the word out to doctors that vaccine is available."
Dr. Michelle A. Gourdine, the Baltimore County health officer, scolded the handful of people with chronic illnesses who told her they were skipping shots so the elderly could get them instead. They thought they were doing a good deed.
"I told them they were wrong," she said. "You need to go get vaccinated."
Couldn't get vaccine
The federal plan to get vaccine to those who need it most has worked only to a point. In a separate national survey, researchers from the Harvard School of Public Health found that more than half of those with chronic illnesses who sought the vaccine in the previous three months couldn't get it. Of those 65 and older who wanted it, 37 percent came up empty-handed.
Of course, no one knows yet how bad the flu season will turn out to be. It can peak as late as February.
"Flu is unpredictable," said Gerberding. "We're certainly not assuming that we're out of the woods yet."
Who needs a shot
All children ages 6 to 23 months
Adults 65 and older
People 2 to 64 years old with underlying chronic medical conditions
All women who will be pregnant during the flu season
Residents of nursing homes and long-term care facilities
Children ages 6 months to 18 years who are on chronic aspirin therapy
Health-care workers who care directly for patients
CDC Web site