Wampum

I once worked with a very good lawyer who had an interesting reaction to bad news. When something bad happened in one of our cases and everyone was running around doing things to try to fix the problem, he would fold his hands over his chest and calmly advise, “don’t just do something, sit there.”

His point was that the period immediately after a problem arises is the time when mistakes are most likely to be made. The best solution to a problem will become apparent only after a little reflection, some serious thought, and a lot of careful planning. Acting before that process is complete is likely to just make things worse.

When it comes to vaccine policy, the Bush administration would be well advised to listen to him.

Last fall, the news broke that there would be a shortage of flu vaccines in the US. The Bush administration decided to do something. It does not appear that they paused for the reflection or planning that my friend would have counseled. Among the things that they decided to do was to look for additional vaccine that could be purchased.

They found some additional doses owned by GlaxoSmithKline at a plant in Germany. The Bush administration decided to purchase at least 1.2 million doses of the vaccine from Glaxo. A little reflection might have revealed that buying that vaccine might cause a couple of problems.

The first problem was that the Glaxo vaccine had not received FDA approval. The N.Y. Times reports:

The secretary of health and human services, Tommy G. Thompson, announced on Dec. 7 that the government had agreed to buy 1.2 million doses of flu vaccines made by GlaxoSmithKline at a plant in Germany that had not previously received approval from the Food and Drug Administration.

Mr. Thompson said that an inspection by the agency had concluded that the vaccines were safe. But since GlaxoSmithKline has not received formal F.D.A. approval for the vaccines, they must be distributed as experimental medicines. Recipients would have to sign consent forms to get the shots. Some will also have to pay special fees.

The special fees and consent forms requirements seem to lessen the usefulness of the purchase:

Ms. Selecky and health officials in Ohio and Nebraska also said that they had no plans to buy the experimental doses, despite tight supplies in some cases.

The state officials said their reasons for not taking the flu vaccine included the difficulty of persuading people to get vaccinated late in the season and fear of the unknown.

"Frankly, our assessment here is that people will be afraid of it," Dr. Nolan said.

Perhaps more damaging than the safety concern is how the administration plans to pay for the vaccine:

To pay for these vaccines, the government will dip into a $220 million grant program intended to help provide routine vaccinations to children who are not poor enough to be eligible under state Medicaid programs, federal officials said. Money for such vaccinations is already so scarce that 19 states have decided not to provide all the recommended vaccines to children who are unable to pay for vaccinations.

One of those 19 states is Nebraska, whose chief medical officer, Dr. Richard Raymond, said that if the federal government cut financing for the children's vaccine program to pay for experimental flu vaccines, his state might vaccinate fewer children. Under the government's plan, money will be deducted from childhood immunization programs to pay for the experimental flu vaccine, even in states that do not receive the experimental doses.

In Rhode Island, which does not plan to ask for the vaccine, that could threaten a fragile system for delivering other vaccines to children, said Dr. Patricia Nolan, director of the Rhode Island Department of Health.

Every child in Rhode Island gets free vaccines under an agreement in which insurers pay into the system as long as both the state and federal governments contribute as well. If the federal government reneges, Dr. Nolan said, she is afraid that the pact will fall apart.

Yum, doesn’t that seed corn taste good? Does it make sense to harm the childhood vaccine distribution system to assist with a short-term flu vaccine shortage? It appears that the need to do something overrode the need to make sure that what was done did more good than harm

The Director of the Centers for Disease Control says not to worry:

It is reassuring that Julie Gerberding, director of the federal Centers for Disease Control and Prevention, has pledged that she will not do anything to jeopardize vaccination of low-income children. The pledge was made after state health officers and prominent medical associations protested that money was being siphoned from a childhood immunization program in order to buy flu vaccines abroad to meet possible shortfalls in this country. The notion of protecting adults at the expense of children rightly struck some state health officers as wrong.

I wonder if the administration has taken the time to reflect on the problem caused by raiding the childhood immunization program, done some serious thinking and some careful planning and come up with a way to reimburse the program without causing additional problems.

If not, the damage may continue to spiral.