Flu Vaccine, Difficult Choices

Posting Date: 12/15/2003

Scientists agonized over flu vaccine

Should they stick with last year?s formula, even though a new strain of the bug was ominously building strength? Or should they try to make a new vaccine and risk complications or delays that could result in a shortage or maybe even no vaccine at all?

In the end, the committee voted 17-1 to bring back last year?s version, even though they feared they were telling millions of Americans to roll up their sleeves for shots that might not work very well.

Many of them probably agreed with Dr. Theodore Eickhoff of the University of Colorado, who said: ?For the first time in many years of participating in these deliberations, I must add I am very uncomfortable with the recommendation.?

What Eickhoff and the others dreaded is exactly what happened. That new strain of flu became the dominant variety, accounting for three-quarters of all cases as the disease got an unusually early start this fall.

About 83 million doses of vaccine were made, but no one really knows how much protection from illness it gives. It almost certainly will not be the usual 70 percent to 90 percent, and some experts fear it is below 50 percent.

?We agonized. We asked repeatedly ?Is there another choice??? remembered Dr. David Stephens, who chaired the panel and heads infectious diseases at Emory University. ?The bottom line is, we weren?t really given a choice.?

Their experience shows the frustrating and often imprecise nature of humanity?s labor to stay ahead of this perennial nuisance and sometime killer.

The flu virus mutates constantly. The Food and Drug Administration, with the help of its expert committee, must decide in late winter what varieties will be the biggest threats. Picking the best combination is a mixture of science, luck and seat-of-the-pants instinct.

?By the time you know what?s the right strain, you can?t do anything about it,? said Dr. Michael Decker, head of scientific affairs at Aventis, one of the three U.S. vaccine makers.

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