Health officials: Vaccine distribution had few hiccups

ATLANTA -- Last fall, as swine flu cases mounted and parents desperately sought to protect their children, the hard-to-get vaccine was handed out in some surprising places: the Royal Caribbean cruise line, the headquarters of drug giant Merck, the Johnson Space Center and a Department of Energy office in Idaho.

In some cases, financial institutions and other recipients got doses before some county health departments and doctors' offices, according to records obtained by The Associated Press through a Freedom of Information Act request.

Also, even though the federal government spent more than $1.6 billion to manufacture and distribute the vaccine, there is no complete record of where it went.

That's "a big deal" -- the absence of complete data makes it hard to spot waste and other problems, said James Colgrove, a Columbia University scholar on the history of immunization campaigns.

A partial picture emerges in thousands of pages of information provided to the AP.

To be fair, at least 85 percent of the doses given in the first six weeks went to groups most at risk for flu complications -- children and other young people, pregnant women and those with certain health problems, according to an estimate from the Centers for Disease Control and Prevention. Wall Street banks and cruise ship companies accounted for a tiny fraction of the 30,000 or so sites sent vaccine in those early days.

Overall, U.S. health officials and a number of outside experts say the vaccination effort went well.

"It was a remarkable logistical success," said CDC director Dr. Thomas Frieden. "As with many things in public health, the things that work really well, nobody notices."

He said the imperfect database is due to limited money and that the agency's top priority at the height of the epidemic was to get the vaccine out as quickly as possible.

But health officials don't know for sure how vaccinations at some venues played out, said Rep. Frank Pallone, chairman of a House health subcommittee.

"How do we know whether or not somebody like Goldman Sachs wouldn't just be giving it to their executives?" the New Jersey Democrat said. "I think the guidelines need to be stricter."

Swine flu, first identified last April, has sickened about 59 million Americans, hospitalized 265,000 and killed about 12,000. The U.S. death toll from the new H1N1 virus, declared a global epidemic, is about one-third of the estimated deaths from a regular flu season. But it was a fearsome threat because children and teens are much more vulnerable to it than seasonal flu.

The vaccine campaign began slowly in early October, with only 11 million doses shipping in the first three weeks of that month, when swine flu was closing schools and approaching its worst, most widespread levels. Ultimately, 86 million people were vaccinated.

The CDC decided how many doses would go to each state, and state and local health departments decided where the vaccine was sent. Doctors' offices, large employers and even federal offices were among those that applied for vaccine. Health officials told them to give it to at-risk people first, but there was no enforcement of that.

It's clear that at many sites, lower-risk people got precious doses in the first two months:

* When a U.S. Department of Energy office in Idaho Falls, Idaho, got about 200 doses in October, officials there offered it to higher-risk employees for four hours. When hardly anyone came, any worker who wanted it was vaccinated, a facility spokesman said.

* Royal Caribbean got 2,100 doses in October and November, vaccinating low-risk crew members along with staffers who care for children on Florida-based ships. The rationale? Employees aboard ships work with the public and would probably come into contact with people in priority groups.

* NASA's Johnson Space Center in Houston got about 800 doses in October and 1,400 more in November, some of which were sent on to other NASA operations. At Johnson, doses were offered first to employees in priority groups, but NASA also set aside doses for healthy astronauts and their families.

* Some doctors' offices gave it to healthy patients if people at risk didn't show up, said Dr. Jim Lederer, an official with Novant Health, a North Carolina-based hospital system.

* Merck got 200 doses in October and 200 in November at its corporate headquarters in New Jersey. A Boeing Co. site in Washington state received 100 doses in mid-October and 100 more the next month. A Hovensa oil refinery in the Virgin Islands got 500 doses in early November, a Nucor Steel plant in South Carolina was given 100, and Hallmark Cards Inc. in Kansas City received 100.

Some of the eyebrow-raising shipments to Wall Street firms like Goldman Sachs came to light last year. The New York Stock Exchange got 200 doses by late October. Morgan Stanley in Purchase, N.Y., received 1,000 doses by early November, though the company said it turned over its entire supply to local hospitals when it learned it got shipments before some area hospitals.

In Georgia, nine prisons and jails got 2,300 doses in October and November. Corrections officials were worried that swine flu would spread fast in crowded lockups.

CDC records show only where initial shipments of 100 doses or more were sent -- not where they all wound up, since that was up to state and local health officials.

To some extent, state and city health departments followed different philosophies. Indiana channeled almost all its vaccine to local health departments. New York City and some states made more use of company health clinics. Which approach worked better is not clear.

Frieden stressed that early shortages were mainly due to manufacturing delays. When the vaccine did come in, getting it out quickly was the top priority -- not making sure every dose got to the most vulnerable people, he said.

The CDC is working out kinks, he added. For example, the agency is replacing a glitchy computerized ordering system that doubled and tripled some of the ordered amounts sent to three states for a couple of weeks.

Given the circumstances, health officials did "a very respectable job," Colgrove said. The assessment might have been harsher had the virus turned out to be more deadly, he added.

"In a way, we really dodged a bullet," he said.