VANISHING VACCINE 2004-11-01 (1)

LIZA CASABONA

The full impact of a graying America was brought home to many retailers last month as seniors lined up en masse to get flu shots.

Supermarkets were caught by surprise by an unprecedented nationwide flu vaccine shortage. They had to work hard at balancing the needs of regular shoppers against the overwhelming attendance at flu shot clinics, usually with lines winding through store aisles.

"We had huge crowds. We probably turned away as many or more as we were able to give the vaccine to, and we were giving out 300 and 400 shots per clinic," said Curtis Hartin, director of pharmacy, Schnuck Markets, St. Louis. " It was mayhem."

Schnucks had lines inside and outside its stores as customers waited. Some arrived six to eight hours early. The chain did its best to make waiting customers comfortable, Hartin said, but the lines unavoidably impacted regular foot traffic in stores. The stores did their best to minimize the effect, he said.

Schnucks was not the only retailer juggling regular customer needs and long lines of flu clinic patients.

"The vaccine shortage created a bit of a nightmare as lines snaked through the stores," said John Fegan, senior vice president of pharmacy, Ahold USA, Braintree, Mass. "There were a lot more patients than there were inoculations available. Our challenge was crowd control and communication with the people waiting in line, many of whom waited overnight."

Ahold chains that conducted vaccine clinics tried to keep patients waiting for shots inside the store, handing out juice, water and cookies, Fegan said. It was impossible to avoid impacting store operations, he added, because many patients in line weren't shopping and regular customers were impeded from shopping certain aisles.

The vaccine shortage was announced in October, following the closure of the British plant of vaccine maker Chiron, Emeryville, Calif. The company said it would not be able to produce the 46 million doses it had promised the United States, cutting the nation's supply almost in half. In the weeks since the announcement, the Centers for Disease Control and Prevention, Atlanta, asked that vaccines be administered only to people in high-risk groups: children aged 6 months to 23 months, adults 65 or older, pregnant women, and persons with underlying medical conditions.

In the intervening weeks, many retailers continued to hold clinics under CDC guidelines until their vaccine supplies ran out. Some like Price Chopper Supermarkets, Schenectady, N.Y., canceled their clinics when the shortage was first made public.

Some retailers still holding clinics have devised strategies to minimize the long lines. Hy-Vee, West Des Moines, Iowa, was administering immunizations based on the doses available in individual pharmacies, but wasn't holding formal clinics.

"Generally, things have been pretty orderly. Some of our stores are giving the shots during pharmacy hours without holding particular clinics for them. Our pharmacists are trained to administer them. That cuts down on lines," said Ruth Mitchell, Hy-Vee's director of communications.

Not all states allow pharmacists to administer immunizations, and some retail chains use a third-party provider. Ahold and Schnucks partnered with Maxim Health Services, Columbia, Md., to administer their vaccine clinics.

Despite crowd control policies put in place by Maxim, such as handing out as many tickets as there were doses available to people in line and turning everyone else away, lines and crowds still formed in stores.

"It became a difficult task giving out shots because of the crowds and the demand. We were seeing anywhere from four to 12 times the demand of a normal year," said Steve Wright, Maxim's national director of wellness services. Many of Maxim's retail partners probably saw their sales decline during clinics, he added.

In addition to Ahold and Schnucks, Maxim administers flu vaccination programs for retailers like Albertsons, Boise, Idaho; Safeway, Pleasanton, Calif.; Kroger, Cincinnati; Publix Super Markets, Lakeland, Fla.; Costco Wholesale, Issaquah, Wash.; Food Lion, Salisbury, N.C.; Shoppers Food Warehouse, Lanham, Md.; Marsh Supermarkets, Indianapolis, Ind.; H.E. Butt Grocery, San Antonio; Walgreen, Deerfield, Ill.; CVS, Woonsocket, R.I.; Eckerd, Clearwater, Fla.; Longs Drug Stores, Walnut Creek, Calif.; Rite Aid, Camp Hill, Pa.; Medicine Shoppe, St. Louis; and a number of independent pharmacies, Wright said.

Other retailers that have canceled their flu vaccine clinics, in addition to those administered by Maxim, include Ukrop's, Richmond, Va., and Hannaford Bros., Scarborough, Maine.

When the Chiron news broke early last month, Maxim had received about half of the two million doses it had ordered from Aventis, Bridgewater, N.J., Wright said. A large portion of its supply was diverted to states that didn't get vaccine shipments through their public health departments.

The company determined that Oct. 16 would be the shutdown date for retail-based flu shot programs. While some of its retail partners do immunizations on their own or employ more than one vendor, the majority of customers contract all of their vaccine clinics to Maxim, Wright said. Schnucks and Ahold stopped holding clinics after Oct. 16. The remainder of Maxim's vaccines will be dispensed in assisted-living facilities, nursing homes and other locations with high-risk patients.

There was no precedent for this year's shortage, sources said. In 2000-2001, when a delay in some vaccines resulted in a temporary shortage, Maxim postponed more than 2,500 clinics for two weeks, Wright said. Those clinics were rescheduled when more vaccine was shipped. With no additional vaccine this year, the problem is of a much greater scale, he said.

Retailers said most customers understand the situation. In one store, Fegan said, customers sang "Happy Birthday" to a 104-year-old woman and let her go to the front of the line. Hartin said he'd received more compliments than complaints from patients, at a ratio he estimated at 25 to 1. Both retailers admitted, however, that while many customers appreciated the clinics, some patients who were not able to get the shot were very unhappy.

Now that many stores have been forced to cancel clinics or have run out of vaccine, retailers are planning for the future.

"This shortage started us thinking about what we can do as a company to provide better communication efforts, to provide better controls, and to assure that the people who truly need a vaccine are the ones that get it in any type of programs involving flu or other types of vaccines," Fegan said. The chain will discuss and plan what it can do differently if a similar situation occurs, he said.

"We haven't even had time to evaluate what to do next year," Hartin said. "Every season is different, and it's difficult to know how to prepare in advance. We had absolutely no warning about the Chiron situation and the flu vaccine shortage [this year]." It's been a few years since there has been a "normal" flu season, he pointed out.

This year's shortage points to changes in the delivery system for vaccines, Hartin added. Five years ago, far fewer people used the flu vaccines, and many manufacturers got out of the business because it wasn't profitable. The problem now is just the opposite as patients clamor for use at levels that strain the current industry resources, Hartin said.

For the 2004-2005 flu season, retailers said they will wait and see what develops in terms of demand for over-the-counter and prescription medications, while promoting basic hygiene to stop the spread of the flu.

Despite media reports about concerns over the supply of antiviral prescriptions like Tamiflu, Relenza, Flumedine and other products that treat flu symptoms in the early stages and reduce their severity, retailers contacted by SN said they had confidence in their supplies of those items for now.

"We have upped our orders for treatments somewhat, but had already placed a substantial order after last year," Fegan said. It's too hard to predict how the flu season will progress this early, he added.

Schnucks increased its supply of flu remedies by about 15%, as a precautionary measure, said Hartin.

Health and Human Services Secretary Tommy Thompson also released a statement in October saying the supply of vaccine and medicines available will be enough to keep people safe during the upcoming flu season. Aventis will make an additional 2.6 million doses of the flu vaccine available in January, he said.

"While we don't have as much flu vaccine as we planned for, the combination of existing vaccine and antiviral medicines gives us the ability to stave off any harsh effects of the flu," Thompson said in a statement.

Additionally, 3 million doses of FluMist, the inhaled flu vaccine manufactured by MedImmune, Gaithersburg, Md., will also be available to patients who don't fall into the high-risk categories.

Even retailers without a pharmacy are planning ahead to meet the needs of customers forced to look for an alternative to the flu vaccine this year. Wild Oats Markets, Boulder, Colo., will merchandise a dedicated "immune support center" this season, said Mary Mulry, senior director of research development and standards for the chain.

"People were coming into our stores asking what they could do if they couldn't get the flu vaccine," she said.

In response, Wild Oats will group homeopathic remedies, vitamins, minerals, probiotics and educational information into a special section, she said. Products reputed to boost the immune system will be featured in store fliers and promotional materials.

While Wild Oats has merchandised sections oriented toward cold and immune support in the past, this is the largest promotion it has done in the category, said Mulry.