Spray vaccine that missed the mark

The concept sounded great: Get protection against the flu with a couple of spritzes into the nose instead of an injection. But FluMist has flopped in its first season, hampered by a price that some found too steep and the fact that the medication can’t be used by those who need protection the most: people younger than 5 and older than 49.

Many people don’t get flu vaccinations because they dislike getting shots. So public health officials hoped an alternative to needle sticks would motivate more people to get vaccinated.

In this case, though, it appears that the price of FluMist, which typically is not covered by health insurance, was too painful. Flu shots run $10 to $20 but are available free at many workplaces, clinics and senior centers; FluMist nasal spray costs $45 to $60.

Price has been the biggest deterrent to the success of FluMist, said Peggy Han, clinical coordinator of community pharmacies for USC. Even with the companies that market FluMist, Wyeth and MedImmune, offering a $25 mail-in rebate, many people don’t want to cover the difference or wait for the rebate.

The companies expected to ship 5 million doses this year, but sales are falling behind, in part because shipments began late. For example, Han began giving flu shots in mid-October and had immunized about 600 people by the time she received supplies of FluMist.

Han said some people who came in for vaccinations decided against FluMist after learning the product contains live vaccine. Even though it’s a weakened live vaccine, people old enough to remember receiving live polio vaccine and not feeling well afterward were wary of FluMist. FluMist can produce nasal stuffiness and a runny nose.

Wyeth and MedImmune remain committed to bolstering FluMist’s sales. Wyeth spokesman Douglas Petkus said the companies would be examining the price issue while continuing to develop a version of FluMist that can be used by higher-risk flu groups and that can be refrigerated instead of frozen.

Many doctors say FluMist use should rise as doctors become more familiar with it.

“There’s probably a learning curve that has to take place ... as to the potential value of the vaccine,” said Dr. Charles G. Prober, a Stanford pediatrics professor who was involved in early clinical trials of FluMist. He gave it to his family, including his college-age daughter, “who faints when she sees a needle.”