Around this time every year, health departments across the state ramp up to battle one of the biggest risks to public health—the flu virus. In 2013, the flu killed more than 300 people in California and sickened thousands more. That’s why the California Department of Public Health(CDPH) provides thousands of free flu vaccines to local county health departments, in an effort to limit the virus’ impact.
But when the NBC Bay Area Investigative Unit began looking into exactly how many of those vaccines actually make it out to the public, we found millions of dollars in waste with minimal oversight. It’s an inefficient system that has health experts raising this question: if counties can’t effectively distribute routine flu vaccines, how prepared are they to respond to other disease outbreaks?
Wasted Vaccines
The NBC Bay Area Investigative Unit reviewed vaccine usage data from CDPH for the past six flu seasons (2008-2009 to 2013-2014). During that time, a total of 528,219 vaccines went unused.
Unlike other vaccines, the flu vaccine is only good for one season before a new strain emerges. Then, any unused vaccines from the previous season must be thrown away.
State records revealed a wide variance between counties and how many vaccines went reportedly unused, ranging from an average 1% unused in Alameda County to 23% in Orange County, to a state-high 38% in Calaveras County.
Local
“That begs the question, why are some counties doing so well and other counties are not,” UCSF epidemiologist Dr. Robyn Gershon told NBC Bay Area.
Gershon said all counties need to have an effective system for distributing vaccines, not only for the flu, but also because it’s good practice for any outbreak.
“This certainly is a great trial run for us to really ramp up, if and when we need to, so let’s hope to get this right. We need to get this right,” Gershon said.
It’s a sentiment echoed by Alameda County’s director of communicable disease control Dr. Erica Pan.
“It is providing a great model for a new pandemic or another strain, if we needed to get a vaccine and/or antibiotics out quickly. [Distributing flu vaccine] helps us practice that procedure and how to coordinate,” Dr. Pan told NBC Bay Area.
This month, Alameda County launched its “Shoo the Flu” program, vaccinating students at Oakland schools. The program is the most recent initiative by the county and its 22 community partners to distribute some 20,000 vaccines this season.
Pan believes that efforts like Shoo the Flu have allowed the county to distribute nearly 99% of its state funded vaccines. “I think we are proactive,” Pan said.
Unused Vaccines
But not all counties have been as successful. Here in the Bay Area, data shows that Marin and Solano counties posted the highest rate of unused vaccine at 19%.
That outpaced counties like Santa Clara at 9% and San Francisco at 8%. ”We’re aiming to use and give out all of our doses of vaccine,” Marin County immunization coordinator Danielle Hiser told NBC Bay Area. Hiser wasn’t in charge of distribution in 2011 when the department reported 38% of its vaccines went unused. She has since worked to add more public clinics to get more vaccines off the shelves and into the community.
“Last year we returned only 5% of our doses and that’s great, Hiser said. “That’s a huge improvement over the past several years.” While Marin County saw improvements last year, other counties in the state failed to report similar improvements.
Solano County’s chief medical officer Dr. Michael Stacey attributed his county’s high volume of unused vaccines to a miscommunication between the county and the state. Earlier this year, his department requested an additional 300 flu vaccines from CDPH. However, the state instead provided 1,300 vaccines.
Dr. Stacey said the county scheduled additional clinics in an attempt to distribute the unanticipated surplus, but they were still unable to use 61% of their available inventory for the 2013-2014 season.
Orange County’s family health medical director Dr. David Nunez said he is aware of the county’s high rate of unused vaccines and said his staff is working to address the issue by reevaluating the number of doses they request from the state going forward.
Health officer for Calaveras County Dr. Dean Kelaita also acknowledged his county’s large quantity of unused vaccines.
“We have a population of around 48,000 people, so we’re small and we get a generous amount [of vaccine] allocated to us,” Dr. Kelaita told NBC Bay Area. Unlike larger counties like neighboring Sacramento, Dr. Kelaita said Calaveras does not have the same public health infrastructure to distribute all of its vaccines. In addition, the county has also seen a steep drop in demand at county sponsored flu clinics from an estimated 500 patients per clinic, to just 60 patients in recent years.
Oversight
While all counties are required to report their numbers to the state, we found that none of the staff at the counties we spoke with had any idea how they compared and there's no penalty from the state if the county consistently fails to distribute vaccines or reports a high level of waste year after year.
At around $11 per dose, unused vaccines have cost the state 5.9 million dollars since 2009.
CDPH declined our request for an interview, but after our public records request this past spring, asking for vaccine data, the state began requiring counties to report their vaccine usage rates in the summer as well as the winter, in order to better track the amount of unused vaccine.
Now, with concerns over the Ebola virus and a vaccine in the works , Gershon says it’s more important than ever, for public health leaders to be prepared.
“If we were to have a vaccine and need to get it out to the entire population quickly this influenza program is the model,” Gershon said. CDPH told NBC Bay Area it is working with county health departments to promote the flu vaccine and to share best practices between counties.
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