Vaccine shortages continue
by Bret Bradigan

While the Federal Drug Administration has issued an alert about critical shortages of many drugs, few problems have been felt in Ojai.
Vaccine supply is another story. This shortage of childhood disease vaccines - including the MMR vaccine for measles, mumps and rubella - is expected to last through the summer, according to the FDA, and some will be hard to get for at least another six months.
According to a story in the Washington Post, Walter A. Orenstein, a physician who directs the National Immunization Program for the federal Centers for Disease Control and Prevention, said, "This is unprecedented. I have never seen anything like the supply problems with this many vaccines in the 24 years I've worked in immunization."
Dutch Atchley, Ojai Rexall pharmacist, said the last time he saw a similar shortage was during the buildup to Operation Desert Storm in 1991. "Four months before all that, we couldn't get certain vaccines," he said.
MMR vaccine is recommended for children ages 12 to 15 months, and then again at ages 4 to 6 years.
Shortages of other drugs have not posed much peril for Rexall customers, yet. For instance, while it has been difficult to get supplies of some commonly prescribed ACE inhibitors for treating high blood pressure, he said, "Doctors can easily switch to an alternative."
Some shortages have become a real pain in the neck, and back. Mike Prater, Ojai Valley Community Hospital pharmacy manager, said that certain forms of injectable steroids for back-pain sufferers have been difficult to find. For certain patients, there are no safe alternatives.
"The impact is, we have to keep putting it (the injections) off. The supply is intermittent," Prater said. The hospital does have an advantage over drug wholesalers, since many manufacturers are willing to sell small supplies directly to hospitals as they come available, but won't sell to big wholesalers they fear might stockpile the drug and create false shortages to drive up prices.
The dynamics of supply and demand can be confusing and trying, Atchley has found. Right now, the supply stream for most drugs is quite steady, he said. "There sure have been increased problems the last two years, but at this time, it's not too bad."
Atchley said, "I've been told a lot of different stories" about the continuing drug shortages." But the key factors appear to be shortages of the raw materials that make up the drugs, marketing campaigns for certain drugs that increase demand, manufacturers' periodic need to retool their machinery to make high-demand, high-profit drugs, and the advent of on-time manufacturing, in which the pharmaceuticals are made to order.
"They learned that from the auto industry," Atchley said.
Prater said that the hospital pharmacy has been chronically short of Depo-Medrol, one of the steroid compounds injected into the base of the spine to provide relief from victims of chronic back pain. But he said alternatives were usually available for doctors to prescribe to most patients.
"There hasn't been any critical shortages of any critical drug," he said.
However, last year the hospital did avert crisis when there was only one snakebite victim treated at the hospital. The hospital, along with the rest of the country, was vulnerable to lack of antivenin, caused when one form of the antivenin was discontinued as production of the new form was still in process.

© 2002 The Ojai Valley News

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