Kathy Griffin saw a silver lining in the dark cloud that emerged last week amid a severe flu vaccine shortage created by the recent shutdown of a Liverpool, England, plant owned by Emeryville, Calif.-based Chiron Corp.
"I'm so excited the press is talking about the break in the supply chain and how fragile it is," Griffin said. "If you have only two manufacturers, when one goes out-this is what happens."
Griffin, director of pharmacy for four-hospital Memorial Health System of East Texas in Lufkin, said such shortages are nothing new. "Pharmacists have been dealing with shortages for quite a while," she said.
The U.K. regulatory authority temporarily suspended the Chiron plant's manufacturing license on Oct. 5. Chiron has since received a grand jury subpoena by the U.S. attorney for the Southern District of New York requesting documents related to its Fluvirin influenza vaccine and the British suspension. Chiron officials said they intend to fully cooperate with the investigation. The Securities and Exchange Commission launched an informal inquiry on Oct. 13 to determine whether securities laws were violated in connection with the plant closure. The company was also the target of at least two class-action lawsuits last week.
The suspension of Chiron's license and shutdown of its Liverpool plant shorted the U.S. flu vaccine supply by about 48 million doses-nearly half what had been expected to be available-and set up a situation ripe for price-gouging. Last week, the American Society of Health-System Pharmacists, or ASHP, reported that a survey of 2,800 hospital pharmacy directors found that more than 55% of respondents reported that they had been contacted by so-called secondary or specialty distributors offering to sell the vaccine at inflated prices. More than 80% said the vaccine was being offered at a mark-up four times its market value of $8 to $9 per dose and nearly 20% said they had been offered the vaccine at $800 or more per 10-dose vial-more than 10 times its original market value.
"It's really quite repulsive that secondary distributors engage in these practices," said Kasey Thompson, director of patient safety for the Bethesda, Md.-based ASHP. "In an environment with short supply and high demand, we need to be vigilant and make sure we are not getting counterfeit vaccine in the supply chain."
Thompson said 16% of respondents said they would pay those steep prices to obtain the vaccine. Some pharmacists also reported that some distributors had solicited them, seeking to buy vaccine from the hospitals, he said. "There is no way in the world anyone would sell to secondary distributors, but it just reflects the nature of the product right now," Thompson said.
The ASHP's report, which was widely covered by the news media, ignited the ire of public health officials. HHS Secretary Tommy Thompson sent a letter to state attorneys general urging them to investigate reports of price-gouging "by immoral individuals looking to make a quick buck off a public health challenge" and to prosecute offenders. Early last week the attorneys general in Florida and Kansas took action against Meds-Stat, a Fort Lauderdale, Fla.-based distributor. Kansas Attorney General Phill Kline alleged Meds-Stat had proposed to deliver and sell a vial of vaccine to a Kansas City pharmacy for $900, knowing that the vaccine was for a nursing home. On Oct. 1, the price for the same vial was listed as $85, he said.
There was also a report that the dearth of vaccine had likely prompted thieves to steal 60 boxes of vaccine from a suburban Denver medical office. In New York, the executive committee of the Greater New York Hospital Association vowed in a resolution that its membership would take all measures necessary to make sure the vaccine reached the people who really needed it. The resolution also called on the federal government to put an end to any price-gouging.
Griffin said she started receiving faxes from distributors hawking the flu vaccine the day after the shortage was first announced. She called one of them-Meds-Stat-and was told that a 10-dose vial would cost as much as $600. Even at that price, she was told she would have to get on a waiting list, she said. Griffin declined.
The local health district's emergency preparedness team, which includes Lufkin's two hospitals, had met early in the crisis to map out a plan, she said. Memorial got enough vaccine to take care of its critical-care nurses and is working on a waiting list for other staff members. The hospital is also using infection-control measures in the emergency room, designating one area to treat flu patients and vaccinating the nurses who will be caring for them, Griffin said. Last year, Memorial inoculated more than 3,000 people, but this year there was just enough flu vaccine to give 800 injections.
"When we got our flu vaccine, I stored it in our narcotic refrigerator, which is under camera surveillance," Griffin said.
Dealing with drug shortages is old hat for Griffin and hospital pharmacists. The ASHP, which has been working on the issue for years, coincidentally published a study in the Oct. 1 issue of the American Journal of Health-System Pharmacy that assessed the depth and breadth of drug shortages and their effects on patient care and hospital costs. Respondents to a survey reported that shortages add an average of $20,000 to a hospital's drug-purchasing costs each year. That extrapolated to $99.3 million in additional costs to the U.S. healthcare system each year, excluding personnel costs, according to the study.
In the case of the flu vaccine, HHS said its immediate focus will be on making sure that the supply reaches the most vulnerable. "We need the help of the public, the public health community and the medical community to make sure that the vaccine goes to those who truly need it most," HHS officials said in a news release.