By Ronda Kaysen
As healthcare providers figure out how to distribute an inadequate supply of flu vaccine to the city’s most at-risk residents, one group in particular has inched towards the bottom of the priority list: the healthcare providers themselves.
Typically, all healthcare providers are offered the vaccine and those working directly with high-risk patients are urged to take it. Healthcare providers are among those singled out on the Centers for Disease Control’s list of priority recipients. But in the face of a national shortage — the American pharmaceutical company Chiron discovered in early October that its 48 million doses of the vaccine, nearly half of the country’s 100 million doses, was contaminated — hospitals and clinics have found their supplies cut by as much as 50 percent and their demand more than double in some instances as people scramble to find a provider who still has the coveted serum.
Some clinics and nursing homes have decided to forgo vaccinating healthcare providers entirely, a difficult choice that may leave patients at a greater risk for illness. Callen-Lorde Community Health Center in Chelsea, which serves the gay and lesbian community, has not vaccinated any of its care providers and neither has Village Care of New York, which runs Rivington House in the East Village — the country’s largest single AIDS residence — and Village Nursing Home in Greenwich Village, as well as its outpatient Chelsea AIDS Day Treatment Program.
Altogether, Village Care serves 1,200 AIDS patients and 500 seniors daily, but has only been able to inoculate 400 people in total, having decided to only treat inpatients at the nursing home and Rivington House.
“We have no vaccine left for our frontline employees and any new residents coming in,” said Arthur Webb, executive director of Village Care.
As of two weeks ago, Village Care finished vaccinating its current resident population, depleting the nonprofit company’s supply entirely. Any new residents — the nursing home and Rivington House both average about 30 new residents a month — and all care providers will not be vaccinated, creating a potentially deadly condition for those elderly residents who are not yet vaccinated.
“You leave vulnerable seniors and people living with AIDS in vulnerable situations leading to unexpected death,” said Webb, who is concerned that a non-vaccinated staff may inadvertently infect its patients. “It’s a problem that could grow quickly into a crisis,” he said.
“It is clearly a totally confusing, chaotic situation, and the federal government just has not taken charge to provide some control or systematic approach to make sure the vaccines are getting to the right people,” Webb added.
Thirty-six thousand people died in the United States last year as a result of complications from the flu — the vast majority of them are elderly. According to a recent New York Times article, that number jumps to 51,000 if complications such as heart attack and stroke are included.
Callen-Lorde does not have enough doses of the vaccine to inoculate all of its H.I.V.-positive and AIDS patients, let alone its physicians. The clinic received 500 doses this fall, but has 2,000 patients seeking the vaccine. They are urging patients to call 311, the city’s non-emergency hotline, to find other options.
Not vaccinating healthcare providers “puts everybody at risk,” said Dr. Rona Vail, an H.I.V. specialist at Callen-Lorde. “However, in the grand scheme of things, we’d rather vaccinate our patients.” She hopes to receive an additional supply in December, although the clinic has not received official confirmation about this. The federal government, she said, “should have insured the better production and outflow of the vaccine.”
Lynn Schulman, a spokesperson for the Gay Men’s Health Crisis Center, thinks the city needs to take a more active role in assuring that H.I.V. and AIDS patients have access to the vaccine. The elderly, she says, have been the primary focus of the vaccine campaign. “Clearly it’s hard enough living with H.I.V.,” she said. “Not being able to get the flu shot on top of that is really a terrible thing.”
Although H.I.V. and AIDS patients are at a greater risk for developing — and dying from — complications from the flu, the elderly are at the greatest risk, according to Vail. “People over the age of 65 are disproportionately the ones who die of the flu,” she said. “But other groups also need it as well. Within the H.I.V. community, the people who are more at risk are the people with moderately to severely compromised immune systems.”
Infants under the age of 2, pregnant women and children and adults with compromised immune systems are also considered “high-risk” patients. According to Vail, anyone in a high-risk group needs a letter of necessity from their physician in order to receive the vaccine.
The C.D.C. insists it is too soon to tell if a vaccine shortage will result in an epidemic. The virulence of the flu strain and the length of the season are two contributing factors to mortality rate that have yet to be determined. A recent New York Times article estimates that as many as 9,000 to 15,000 additional Americans will die from the flu this year, and far more if a serious outbreak occurs.
At NYU Downtown Hospital, in the Financial District, Dr. Chester Lerner, the hospital’s director of infectious diseases and infection control, is hopeful — but not certain — the healthcare providers at his hospital who work directly with ill patients will be vaccinated. “We are immunizing them right now,” he said in a telephone interview. “We hope to have enough for those people.” The hospital does not, however, have enough vaccine for all its workers. In previous years, all healthcare workers at NYU Downtown were offered the vaccine. But this year, lower-risk workers are being asked to forgo the shot.
St. Vincent’s Hospital in Greenwich Village is in a similar situation to NYU Downtown Hospital. “We have a very tight supply because of the shortage,” said Maura Duffy, a spokesperson for the hospital. There is enough of the vaccine, however, for at-risk patients and frontline staff. Like other local clinics and hospitals, St. Vincent’s is holding out for reinforcements. “We are aggressively trying to get more [of the vaccine] from state and local channels,” she said.
The city’s Health Department sees a light at the end of the tunnel. “New Yorkers are beginning to get a handle on the situation with respect to the vaccine,” said Sid Dinsay, a Health Department spokesperson. “Private doctors and hospitals are beginning to get their vaccines slowly but surely.” The Health Department is urging low-risk New Yorkers to forgo the vaccine this year and take precautions — washing hands frequently, staying home when ill and avoiding shaking hands with sick people — to prevent the spread of the flu.
With the elderly waiting in long lines that have often not materialized in an inoculation at all, many providers worry that heightened anxiety may be the first of the unexpected complications from this year’s flu. Eleanore Z. Kroman, chairperson of the board of directors for Caring Community, a group serving seniors in the Village, has been urging her members to stay calm. “You can’t really panic,” she said. “Whatever you have, be it a heart trouble or something else, will be aggravated. It doesn’t help you at all.”
Despite her call for patience, Caring Community, which currently runs three inoculation centers in the Village, does not have enough vaccine for all of those seeking one. “We will be lucky if we can take care of all those people who already have appointments with us,” Korman said.
Demand for the vaccine, Korman says, is “way outside” of the norm. In addition to the 300 people who currently have an appointment, Caring Community has compiled a long waiting list for hopeful recipients. A senior herself, she was inoculated recently along with her husband, both of whom are “at very high risk” for developing complications from flu.
Callen-Lorde’s Vail attributes this year’s crisis to a nationwide lack of public healthcare. “It’s a very big deal that we don’t have a public infrastructure that insures the production of the vaccine,” she said. Pointing to Europe as a successful example, Vail insists the government should have relied on more than two private companies to produce the vaccine for the entire United States population. “We can subsidize tobacco farmers, but we can’t subsidize the providers of vaccines,” she said.
The Health Department announced the first flu outbreak last week — at a nursing home in Manhattan.
