It's the time of year when the Centers for Disease Control and Prevention tells Americans to get their flu shots or the nasal spray vaccine, for healthy people between the ages of 5 and 49. Apparently it's also the time for annual confusion about just when flu vaccine will be available -- and where.
Some doctors are already reporting they don't have the flu vaccine they need, while large retailers are advertising early-October vaccine clinics.
Family physician Leonard Finn ordered flu vaccine for his patients in February. But so far, he and his colleagues in Natick, Mass., have received only 10 percent of what they need for the 700 patients in their practice who are at high-risk of flu complications.
Last week at a medical meeting, Finn asked 22 family doctors from around the Northeast if they were in the same boat. All but three said yes.
"We're talking about 19 out of 22 doctors with zero or less than 10 percent of their vaccine order," Finn says, "while big chains everywhere have all the vaccine they need."
It irks Finn to hear federal health officials urge Americans to get immunized against the flu before doctors have the vaccine.
"It's very frustrating for them to say there's vaccine," Finn says, "and then for patients to come in, and you say you don't have it. It's infuriating."
CDC officials say they don't control the nation's complicated flu-vaccine-distribution system.
But Jeanne Santoli, deputy director of the CDC's immunization services division, says the agency urges manufacturers and distributors not to favor big retail chains over doctors' offices. She says the CDC wants to be sure people at highest risk for flu complications get vaccinated.
"Everybody serves some patients who are at the highest risk," Santoli says. "A provider's office certainly does. Walgreen's certainly does."
So it doesn't make sense, she says, to disadvantage doctors, who provide 70 percent of flu vaccinations.
According to Santoli, vaccine suppliers have said they're cooperating with the CDC's plea to be fair.
"What we've heard from the manufacturers and distributors is that they are not favoring larger customers or orders over others," Santoli says.
But Mark Mlotek of Henry Schein, Inc. -- perhaps the largest distributor of flu vaccine to doctors' offices -- says the CDC has not put out a clear message about how vaccine should be distributed.
"I would have to say no, we don't have that recommendation from the CDC this year," Mlotek says.
In the end, the CDC says there should be no shortage of flu vaccine this year. In fact, there will be more than ever before – at least 100 million doses. But Mlotek says it's only beginning to arrive from his suppliers.
"We don't have a lot of flu vaccine yet. It's going to be coming every week from now until December," he says.
Until shipments ramp up, he predicts there will be feast and famine on the vaccine landscape.
"Will there be Wal-Marts that have it and doctors' offices that don't? Yes, I believe that will happen again this year," Mlotek says.
The CDC is mindful of the problem. So this year it's putting out a more nuanced message: not "Get your flu shot," but "Get your flu shot, just don't get it too soon." The CDC says it's OK to wait until November or December, or even later.
The bigger problem is indicated by a new national survey conducted for the National Foundation for Infectious Diseases. Less than half the respondents say they plan to be immunized against the flu. But the CDC's recommendations for who should get vaccinated totals 218 million Americans, nearly three-quarters of the population.
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