Now there’s plenty of H1N1 flu vaccine

The H1N1 flu vaccine shortage has become a surplus.

Out of nearly 120 million vaccines distributed nationwide -- 4 million to Los Angeles County alone -- only about 70 million have been used, according to federal officials.

An additional 35 million doses have been produced but not shipped and instead may be donated overseas.

Last month, officials with the California Department of Public Health s said they were holding back 1.5 million doses to begin building a stockpile for the next flu season. At that time, new orders had come to a near halt.

So a vaccine that just months ago was so scarce that people camped out at free clinics for the chance to get it is now the subject of a different scramble: What should happen to the unused doses?

Some providers report confusion about what to do and frustration with a distribution system that has made it difficult to know whether their unused doses, some of which are about to expire, are needed by another doctor to vaccinate patients.

State public health officials say that although doctors may now refuse to accept previously ordered shipments of H1N1 vaccine, once they sign for the doses the state will not take them back. At that point, said Mike Sicilia, a spokesman for the state public health department, it is up to the provider to consult with local health officials.

In some cases, doctors said they have been rebuffed by county health officials when they attempted to give back surplus vaccine so it could be redistributed.

Los Angeles County, for example, is not accepting returns.

“We’re telling people to use what they have,” said Dr. Jonathan Fielding, the county’s director of public health. “Some providers have more vaccine than they have demand, but that could change tomorrow if a third wave started. We don’t really know what the future holds -- influenza is a very unpredictable disease.”

But many doctors report that demand is simply no longer there, in some cases leaving them with thousands of doses of the once-hot vaccine.

The federal government paid the manufacturers for the vaccine and distributed it free to the states.

Steven Abelowitz, a Newport Beach pediatrician, initially received 15,000 doses of the vaccine in October. He gave 10,000 to his patients, 3,000 to fellow doctors and 2,000 to Orange County’s public health agency. Dr. Nancy Bowen, the agency’s chief medical officer, said her office had a list of providers serving those most at risk of catching H1N1 flu and redistributed the extra vaccine to them.

Abelowitz has since received a second shipment of several thousand doses and is trying to return some to the county. Other doctors have made no effort to share, he said, exacerbating the uneven distribution.

“There are plenty of providers who got it who kept a low profile,” he said. Those doses are “sitting in their fridges and are getting expired.”

In L.A. County, it remains unclear how many of the 4 million doses distributed have been used. Also unknown: a full accounting of which providers got the vaccine, when they got it and how much they received.

Fielding’s department, along with state and federal health officials, has so far refused to release a list of doctors, clinics and other private healthcare providers who ordered the vaccine, citing privacy concerns.

The surplus is not universal, raising more questions about how distribution has been managed.

At Cedars-Sinai Medical Center, officials this week ordered 6,000 new doses of the vaccine after manufacturers announced some batches were expiring mid-month, a few weeks earlier than expected.

Hospital officials initially ordered about 20,000 doses, received half that and vaccinated thousands, including 6,000 staff members.

“We’re concerned -- we thought we had a lot, but now it’s expiring,” said Dr. Rekha Murthy, director of hospital epidemiology at Cedars. “We want to act quickly to make sure we have ample supply.”

The UCLA hospital system, on the other hand, has used less than half of its order of about 45,000 doses, according to Bill Dunne, director of emergency preparedness. He said hospital officials plan to continue vaccinating as many patients and staff as they can rather than return the extra vaccines, especially since some batches expire Feb. 15.

The hospitals had faced an H1N1 vaccine shortage in the fall, when they received only a few thousand doses. The bulk of their shipment arrived Dec. 23, well after flu infections had peaked in late October.

“There seems to be a perception in the public that the disease has come and gone and there’s not a need to get the vaccine,” Dunne said.

The story is the same elsewhere.

“We were scrambling for it, and all of a sudden there was plenty around,” said Dr. Stephanie Booth, a pediatrician in Rancho Palos Verdes who sees about 200 patients a day.

At Salimpour Pediatrics in Sherman Oaks, Van Nuys and Panorama City, Dr. Ralph Salimpour has 1,000 vaccines left, about a third of what he ordered. He received his first shipment in late October and has already given away several hundred doses to colleagues, he said.

“The good news is that the H1N1 pandemic was not as bad as we expected,” he said. “We are hoping there won’t be another wave.”

Still, some pediatricians said they wished the initial distribution had gone differently. Booth, the Rancho Palos Verdes practitioner, said she wished doctors could have bought the vaccine directly from manufacturers without having to go through government bureaucracy.

“Going through the shortages and all was really very frustrating for us,” she said, “and did not seem particularly fair.”

molly.hennessy-fiske@latimes.com