Flu Vaccine, Difficult Choices

Posting Date: 12/15/2003

?This is a very urgent issue,? CDC flu chief Nancy Cox told the committee. ?We?ve been working on this very intensively for what seems like a very long time. We?re very disappointed.?

Still ahead were many other steps, as well. The Fujian strain?s hemagglutinin and neuraminidase genes would have to be transferred into tame flu viruses that grow nicely in hens? eggs so vaccine makers could produce them in bulk. Even then, it would take weeks to know if the process would reliably generate the vast quantities needed.

?It became, Do we go with a vaccine we know will be partially effective?? remembered Eickhoff. ?Or do we wait around and try to identify a possible candidate strain??

When the vote came, only Peter Palese, head of microbiology at Mount Sinai School of Medicine in New York, chose to switch to the Fujian strain despite the unknowns. He worried that an ineffective formula would give the flu vaccine a bad name because many people might get sick.

The WHO made the same decision as the FDA. In hindsight, was it correct?

Decker recalled what happened in 2000. Delays resulting from a switch to a new strain, along with a virus that produced poorly, contributed to a vaccine shortage.

A last-minute change to Fujian this year ?could easily have meant not only a severe shortage but also the wrong vaccine,? he said. ?Right now, people are saying, ?You idiot, why didn?t you choose Fujian?? But what if Fujian had petered out??

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