Medical Examiner

Why Is It So Tough To Get a Flu Vaccine?

Pity the poor slackers come January.

How long would you wait for one of these?
How long would you wait for one of these?

Lionel Bonaventure/AFP/Getty Images.

How long would you stand in line for a flu shot? Not at gunpoint, but voluntarily? Last weekend I had an opportunity to ponder the question.

Both my kids normally get their flu shots by Halloween, despite my daughter’s terror-stricken fear of needles. But this fall, though the husband and I kept saying we were going to track down FluMist, somehow it never happened.

In the New Year, reports of children dying from the flu served as a wake-up call. The vaccine isn’t a magic shield against influenza, particularly if you’re over 65, but it does have protective effects, and it’s safe. For most people, it’s the smart thing to do.

But by the time I called our pediatrician, FluMist, the nasal-spray version of the vaccine, had wafted into the sunset. In fact, our doctor’s office had run out of flu vaccine altogether. A staffer explained they wouldn’t get more because of a shortage.

Stories out of Michigan and Texas have reported local shortfalls. But did that mean there were shortage shortages? Were latecomers like my kids and myself out of luck, with the worst of the flu season still to come? (According to the Centers for Disease Control and Prevention, flu usually peaks in late January or early February.)

Friday, I called my local CVS pharmacy to see if they had doses on hand. The automated phone system had a jolly recorded message. (“Flu shots available every day! Walk in any time.”) But once I talked to a human, I learned the pharmacist didn’t administer shots to young children. They did, however, have a “MinuteClinic” on site, and it was all set with appropriate doses for my kids, ages 8 and 6.

Sunday morning, we climbed into the family van and headed to the closest MinuteClinic. I put a new tiny dollhouse, still in its wrapping paper, on the seat next to my daughter, promising that if she didn’t have a psychotic break inside, the toy would be waiting for her in the car. It was 9:47 a.m.

When we got there, a computer screen at a sign-in kiosk informed me the clinic was out of flu shots. We drove to another MinuteClinic, only to come up empty-handed again. My husband, who had to work that day, bailed on us but wisely handed over his Angry Birds-equipped cell phone.

I called four more clinics—taunted each time by the phone message inviting me to get a shot—until I finally found one that still had children’s doses. But it was first-come, first-served. We got back in the car for the fourth time, my daughter staring longingly at the toy next to her and saying, “I hope I get my flu shot soon.”

When we arrived at 11:43, I imagined this MinuteClinic as nirvana, where we would be protected from what is shaping up to be the worst flu season in a decade. But we ended up 15th on the list, with one nurse on duty and children littering the carpet in front of the clinic. Were there enough doses left? I began polling people as diplomatically as possible on their medical conditions. Perhaps they were just sick and didn’t need a vaccination today?

CVS says the chain has already administered more than 3 million doses of flu vaccine this season, up about 50 percent from last year. That’s quite a bump in delivery, yet RAND researcher Lori Uscher-Pines says that U.S. pharmacies still provide far fewer vaccinations than doctors’ offices.

For my family and other slackers, the pediatrician was no longer an option. We were stymied by a system in which everyone has to guess far in advance how much vaccine is needed without knowing what a given flu season will look like. If a medical practice buys too many doses, it ends up eating the cost of the unused supply. So some years they won’t have enough.

A key issue, according to Uscher-Pines, is that the process of creating vaccines is not just long but unpredictable. We’re using antiquated 1950s technology to culture and grow vaccine in eggs—it’s a little like planting a crop. So manufacturers, who have a low profit margin to begin with, start a delicate process several months ahead of each season. By the time we have a clear picture of demand for vaccine, supply is fixed. We just have to hope that we don’t get a lousy harvest during a year when a devastating flu strikes.

There are options available in true crisis years. Beginning in 2004, the CDC created an emergency stockpile for children. Five years later, during the swine flu epidemic, the government centralized vaccine distribution on an emergency basis. But for now, except in that kind of crisis, once doses are out in the world, there’s no system in place to reallocate them in the event of spot shortages.

As long as vaccine production methods remain more or less the same, responding to surges in demand for flu vaccine will continue to challenge public health planners. And doctors may find they’re unable to provide shots for patients come January.

Which left us dependent on the kindness of MinuteClinic. Despite my survey of waiting patients, it was impossible to calculate whether we would get our shots that day. Cute but crud-eyed children pulled pink metal roadsters off the shelves and zoomed them over the carpet. Store employees took the long way around to avoid us. Adults slouched in the half-dozen chairs available, with surplus people standing up or sitting on the floor, waiting to be called in or called home.

Twenty minutes later, the nurse’s door still hadn’t opened. A big woman in tiny suede boots volunteered that she had already been there two hours and was now 11th on the list. When the nurse finally popped out for the next patient, we were told that she could probably see only one or two more people before her break.

It was 12:10. We headed to Wendy’s and came back an hour later. Suede boots had moved up two slots in our absence. We sat down, but after a while, I started to worry about our sick, old dog left alone at home. Doing a quick and dirty calculation in my head [30 min. per non flu-shot patient x (4 to 6) patients ahead of us + (4 to 6) flu-shot patients at 15 minutes each], I decided that we surely had 45 minutes to check on the dog and come back.

We returned by 2:30 to discover that some patients had bailed. We were No. 3! And we only had to wait another hour to see the nurse, who even with a mob lurking outside her door, turned out to be professional and friendly. “You should have seen this place yesterday,” she said.

In the last minutes before her shot, my daughter started climbing on me and begging to go. But by the time the needle came out, it was 3:45—six hours since we had set off that morning—and she was too exhausted to commit to a freakout.

Leaving, I waved to the crowd. “That didn’t take long,” someone from the appreciative mob said. In the car, my daughter ripped open her new toy.

Now, there’s just one problem left. The nurse was out of adult flu vaccine. So I didn’t get a shot.

The flu generally kills between 3,000 and 49,000 people in a given season, even in non-pandemic years. FDA spokeswoman Rita Chappelle said Monday that as long as demand doesn’t surge much higher than in previous years, the agency doesn’t expect to see any real vaccine shortages, just occasional gaps. CVS’s Mike DeAngelis says that when temporary shortages occur, he expects stores to be restocked quickly.

Still, hitting the jackpot is a guessing game. Wednesday, I called the six CVS locations that had been out over the weekend, and only two of them had doses on hand.

Uscher-Pines delicately pointed out to me that it’s smarter and easier to get vaccinated in September—and suggested families make it part of a back-to-school routine. For bad parents like me, she helpfully noted this CDC vaccine finder.

So maybe I’ll see you at a local clinic. But given my weekend, you’d better call ahead. And pack a lunch.