Anthrax Isn’t the Only Vaccine Problem

After recent events, many people are thinking about being vaccinated against anthrax and are swamping their doctors with requests for the currently unavailable smallpox vaccine.

But exotic bugs may not be our biggest problem. We are short of everyday vaccines, limiting our ability to optimally immunize infants and children as well as the elderly. You may not think of this as a serious problem because diseases such as diphtheria and tetanus have just about disappeared from our national consciousness. So let me lead you on a brief trip backward in time.

Had you been a new parent in the 1920s, you would have looked at your wiggly little bundle of hiccups and squeals with some trepidation. Babies didn’t survive as reliably in those days. In 1921, more than 200,000 cases of diphtheria were reported. In 1994, there were only two. A quarter of a million people got pertussis--whooping cough--in 1934. By 1994, that was down to 5,000. Babies are the most likely to die of whooping cough.

Tetanus, a bacterium that lives in the soil, contaminates cuts and produces a toxin causing lockjaw, spasms and seizures. It claimed 30 times the number of victims in 1923 that it did in 1994.

Current scarcities of the vaccines against diphtheria, tetanus and in some cases pertussis threaten to reactivate these diseases. The potential harm done by a release of these diseases on an inadequately vaccinated population is far worse than the handful of anthrax cases we’ve experienced.

Between 1990 and 1993, Russia experienced a threefold rise in reported cases of diphtheria, the largest outbreak in the developed world since the 1960s. More than 10,000 people were stricken in 1992 and 1993; about 500 died.

Although 90% of Russian schoolchildren were completely vaccinated against this disease, many babies younger than 1 had not received a full series of three vaccinations. And the epidemic occurred mainly in those older than 14, whose immune status had waned over time.

In the United States, we no longer have enough diphtheria-tetanus vaccine to routinely vaccinate older children and adults because our limited supply is channeled to emergency rooms, public health clinics and other sites where acute injuries mandate tetanus shots. This scarcity potentially could replicate the Russian epidemic.

Spot scarcities and delays also exist for the new pneumococcal and influenza vaccines and even on occasion for chickenpox vaccine.

U.S. vaccine production and delivery rest largely within the private sector. Pharmaceutical companies have shown great creativity in developing new and effective vaccines, but vaccine production is not always as profitable as other drug products. This is especially true of the older vaccines, including the diphtheria and tetanus, whose prices are regulated.

The pneumococcal vaccine Prevnar will be scarce for an estimated six months, apparently because its success has exceeded initial usage projections.

Newer recommendations call for deferral of vaccination of children at lesser risk of invasive pneumococcal disease until the supply of vaccine is expanded.

Some doctors say pharmacy chains are holding flu immunization clinics as a merchandising tool. More affluent people get their flu shots whether they need them or not, while doctors can’t get the same vaccines for poor patients who have asthma or chronic lung disease.

Of all modern medical miracles, vaccines still hold the uncontested record for the vast numbers of lives saved. We must maintain vaccine availability for all, especially the infirm and those living in poverty. Self-interest alone should motivate this: The inner-city child who gets diphtheria or influenza can easily transmit that microbe to other children in school or to shoppers at malls.

Pharmaceutical companies must be encouraged--and appropriately rewarded financially--to develop new medicines and vaccines, including a stronger vaccine for anthrax. But perhaps tried and true old vaccines--whose financial glitter has long since eroded--need to be produced and distributed by the federal government to ensure reliable supplies.

We are in an eternal war with microbes and will be after the last terrorist has been vanquished.