Alison is a 19-year-old university student with moderately severe asthma. She was hospitalized once when she was twelve
Posted: Mon May 02, 2022 8:33 pm
Alison is a 19-year-old university student with moderately
severe asthma. She was hospitalized once when she was twelve and
caught a bad cold, and she has had some serious attacks in the past
few years. If Alison were to catch the flu, it would likely cause
an even more severe inflammation of the lungs than a cold, leading
to even more severe asthma attacks 1. Alison would be unable to
breathe and her fast-acting inhaler might not be enough to clear
her airways. Getting a flu vaccine is Alison's best defense against
getting the flu in the first place; it can cut her risk of getting
the flu by up to 90 percent. When she was a child, her mother
always took her to get her flu vaccine, and since she has been away
at school she has been careful to get her own yearly vaccination.
Unfortunately, this year there is a shortage, making it difficult
to obtain the seasonal flu vaccine. Influenza vaccines are not
considered very profitable to make, because they are expensive and
any extra has to be thrown away at the end of the flu season, since
a new vaccine must be produced every year. Consequently, not many
companies produce the flu vaccine. Given that no single person or
agency is in charge of ensuring that the United States has an
adequate supply of influenza vaccines, it is not surprising that
shortages do occur. This year, one of the companies, in charge of
producing nearly half of the United States' supply, had a bacterial
contamination that forced them to shut down all vaccine
production.
Alison is very afraid of catching the flu. Her worst asthma
attacks have been when she had a cold, and she is terrified of not
being able to breathe. Alison wants to be sure to still get her
yearly flu vaccine, but there is currently no system in place to
ensure that at-risk populations receive the limited supply of
vaccines available. It is entirely dependent on each clinic to try
to ration their limited supply. To do this, some clinics attempt to
use medical necessity criteria, which are challenging to define;
Medicare defines medical necessity as "services or supplies that
are needed for the diagnosis or treatment of your medical condition
and meet accepted standards of medical practice." This is a
subjective standard, and is frequently assessed by an insurance
company that never sees the patient, to determine if payment will
be issued. Alternatively, many clinics avoid the issue by using a
lottery. The most common method of distribution, however, is a
"first-come first-served" basis, with some consideration of medical
necessity requirements.
In Santa Clara county in the 2009 H1N1 vaccine distribution, the
initial shipment to arrive was a nasal form of the vaccine, so it
was limited to healthy children 2 years and older, especially those
younger than 10 years who are recommended to receive two doses; and
healthy household contacts (2 - 49 years) of infants younger than 6
months 2. The next shipments of the injection vaccine were then
directed towards high risk groups such as pregnant women, household
contacts and caregivers for children younger than 6 months of age,
health care professionals, all people from 6 months of age to 24
years old (due to their particular vulnerability to H1N1), and
people aged 25 to 64 who have medical conditions such as asthma
that put them at a higher risk of complications from the flu.
To ensure that is she is among the lucky few who receive a
vaccination this year, Alison gets up at 4:00 in the morning on a
Friday and drives to the nearest clinic, which opens at 6:00 a.m.
This clinic is the only clinic within 50 miles of Alison's home to
have received any vaccine supply, so everyone from the surrounding
area is also coming here for their supply. Arriving shortly after
4:30 a.m., she is number 62 in line for the vaccine. If she does
not make it to the front of the line before all the shots are gone,
she will not receive a vaccine. If she makes it to the front, but
is determined not to be "enough" at-risk because she is not a
senior, she will not receive a vaccine. Seniors are especially at
risk for contracting pneumonia or bronchitis given their generally
lowered levels of activity and weaker immune systems.
Alison finds herself in line behind a sixty-three year old man
who doesn't have any money to pay for the vaccine, but is not yet
eligible for Medicare. Seniors are generally considered one of the
high-priority groups for getting the flu vaccine, because they tend
to have weaker immune systems and therefore develop more
complications that are frequently fatal. He tells Alison that he is
nervous that he will be turned away because he cannot pay, even
though he is very close in age to the at-risk population. He also
mentions his daughter who wanted to bring her two young children to
try and get the vaccine, but she works at a nearby canning factory
and couldn't get the time off to bring them to the clinic. Up at
the front of the line there is some commotion over a young man
being turned away because he is not considered at-risk. He can be
heard shouting, "I'll pay anything, just give me the vaccine!"
severe asthma. She was hospitalized once when she was twelve and
caught a bad cold, and she has had some serious attacks in the past
few years. If Alison were to catch the flu, it would likely cause
an even more severe inflammation of the lungs than a cold, leading
to even more severe asthma attacks 1. Alison would be unable to
breathe and her fast-acting inhaler might not be enough to clear
her airways. Getting a flu vaccine is Alison's best defense against
getting the flu in the first place; it can cut her risk of getting
the flu by up to 90 percent. When she was a child, her mother
always took her to get her flu vaccine, and since she has been away
at school she has been careful to get her own yearly vaccination.
Unfortunately, this year there is a shortage, making it difficult
to obtain the seasonal flu vaccine. Influenza vaccines are not
considered very profitable to make, because they are expensive and
any extra has to be thrown away at the end of the flu season, since
a new vaccine must be produced every year. Consequently, not many
companies produce the flu vaccine. Given that no single person or
agency is in charge of ensuring that the United States has an
adequate supply of influenza vaccines, it is not surprising that
shortages do occur. This year, one of the companies, in charge of
producing nearly half of the United States' supply, had a bacterial
contamination that forced them to shut down all vaccine
production.
Alison is very afraid of catching the flu. Her worst asthma
attacks have been when she had a cold, and she is terrified of not
being able to breathe. Alison wants to be sure to still get her
yearly flu vaccine, but there is currently no system in place to
ensure that at-risk populations receive the limited supply of
vaccines available. It is entirely dependent on each clinic to try
to ration their limited supply. To do this, some clinics attempt to
use medical necessity criteria, which are challenging to define;
Medicare defines medical necessity as "services or supplies that
are needed for the diagnosis or treatment of your medical condition
and meet accepted standards of medical practice." This is a
subjective standard, and is frequently assessed by an insurance
company that never sees the patient, to determine if payment will
be issued. Alternatively, many clinics avoid the issue by using a
lottery. The most common method of distribution, however, is a
"first-come first-served" basis, with some consideration of medical
necessity requirements.
In Santa Clara county in the 2009 H1N1 vaccine distribution, the
initial shipment to arrive was a nasal form of the vaccine, so it
was limited to healthy children 2 years and older, especially those
younger than 10 years who are recommended to receive two doses; and
healthy household contacts (2 - 49 years) of infants younger than 6
months 2. The next shipments of the injection vaccine were then
directed towards high risk groups such as pregnant women, household
contacts and caregivers for children younger than 6 months of age,
health care professionals, all people from 6 months of age to 24
years old (due to their particular vulnerability to H1N1), and
people aged 25 to 64 who have medical conditions such as asthma
that put them at a higher risk of complications from the flu.
To ensure that is she is among the lucky few who receive a
vaccination this year, Alison gets up at 4:00 in the morning on a
Friday and drives to the nearest clinic, which opens at 6:00 a.m.
This clinic is the only clinic within 50 miles of Alison's home to
have received any vaccine supply, so everyone from the surrounding
area is also coming here for their supply. Arriving shortly after
4:30 a.m., she is number 62 in line for the vaccine. If she does
not make it to the front of the line before all the shots are gone,
she will not receive a vaccine. If she makes it to the front, but
is determined not to be "enough" at-risk because she is not a
senior, she will not receive a vaccine. Seniors are especially at
risk for contracting pneumonia or bronchitis given their generally
lowered levels of activity and weaker immune systems.
Alison finds herself in line behind a sixty-three year old man
who doesn't have any money to pay for the vaccine, but is not yet
eligible for Medicare. Seniors are generally considered one of the
high-priority groups for getting the flu vaccine, because they tend
to have weaker immune systems and therefore develop more
complications that are frequently fatal. He tells Alison that he is
nervous that he will be turned away because he cannot pay, even
though he is very close in age to the at-risk population. He also
mentions his daughter who wanted to bring her two young children to
try and get the vaccine, but she works at a nearby canning factory
and couldn't get the time off to bring them to the clinic. Up at
the front of the line there is some commotion over a young man
being turned away because he is not considered at-risk. He can be
heard shouting, "I'll pay anything, just give me the vaccine!"