State supplying fewer vaccines this year

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-this-year

State supplying fewer vaccines this year.

By Morton/Daily News staff

MetroWest Daily News

Posted Aug 20, 2011 @ 11:43 PM

Faced with a money crunch, the state has cut in half the number of adult flu

shots provided to shelters, community clinics and health boards, which coupled

with restrictions on other vaccines, has left patients scrambling to find

alternatives.

The changes primarily hurt adults, since a federal program is picking up the

slack for children. Besides flu shots, the cuts include vaccines targeting

hepatitis A and B, chicken pox, measles, mumps and rubella.

Those cuts could hurt Massachusetts' high rates of immunization, achieved

through an emphasis on vaccinations and the public health system.

" Our biggest concern is that vaccine may become less accessible to the most

vulnerable members of our society, " said Manley, a spokeswoman for the

state Department of Public Health. " The worst-case scenario is that we will

experience an outbreak of a vaccine-preventable disease. "

In Framingham, the Board of Health administered 45 doses of hepatitis A and 55

of B from January to June, but received just 10 shots of each for the entire

fiscal year that began last month. Town flu doses fell from 6,000 to 2,000.

Despite limited revenue, the Legislature actually increased the state's vaccine

budget, from $50.1 million to $51.3 million. But given higher prices, expanded

coverage recommendations and the end of federal stimulus aid, Manley's

department still had to impose new restrictions.

" That does pose a challenge, " said Natick's public health nurse, Leila Mercer.

In the past, health boards simply asked for yearly replacement of used doses.

But with the exception of a combination tetanus-diphtheria shot, all adults

receiving state doses must now lack insurance and meet specific recommendations,

typically based on age, medical history, job or lifestyle.

While technically the regulations still welcome those whose plans don't cover

vaccinations, the federal health care law dictates that private insurers join

Medicaid and the state's other public plans in offering the services without

out-of-pocket costs by Sept. 1.

For flu, the state is no longer providing vaccine to long-term and assisted

living facilities and to private offices treating adults. Once it's satisfied

that children are sufficiently covered, it will allow public sites to vaccinate

adults who are 50 and over, pregnant or chronically ill.

Flu vaccine purchases fell from 1.1 million to 870,000 - a 23 percent drop, or

up to a 55 percent hit for adults once the children's projected allotment is

factored out. While only 891,000 of the ordered doses were used last year, a

high-demand season could complicate the state's plan.

" We never know how much vaccine will get utilized, " said Masciarelli, whose

Visiting Nurse Association of Greater Milford has squeezed extra flu vaccine for

nine member towns into its budget. " That's part of the dilemma for the state. "

The state is working with the business group Associated Industries of

Massachusetts to increase office flu vaccinations. Already 20 percent of

residents get their shots at work.

The state also is working with health boards to get them insurance

reimbursements. While most only offer flu shots, Framingham and Natick offer

other vaccines as well.

Framingham Public Nurse Kitty Mahoney said the state's goal is to move patients

toward primary care offices and take advantage of its success in getting 98

percent of residents covered with health insurance.

" That's not a bad idea, it's just that the move came very swiftly, " she said.

One problem, Mahoney said, is the ongoing shortage of primary care doctors and

the long waits for appointments. Another catch: Apart from flu, tetanus and

pneumonia, many practices don't offer vaccines because of their tricky storage

and handling needs, burdensome paperwork, and complicated dosing schedules.

Mahoney is referring non-qualifying patients to the travel clinic at MetroWest

Medical Center or the CVS MinuteClinics in Ashland, Natick, Northborough, Medway

and lin.

But MinuteClinic has no plans to carry the vaccine for chicken pox - varicella -

or the combination one for measles mumps and rubella - MMR. Those are two of

Framingham's most-requested vaccines, along with hepatitis A and B.

While both varicella and MMR are given to children, the chicken pox vaccine is

fairly new, so adults might not have coverage from doses or an earlier bout.

They might also come from abroad, or not have records handy for school or work.

In Natick, the health board has set up a special self-funding account, where

town residents can get flu or pneumonia shots for free but are asked to provide

health insurance information. Mercer hopes to expand the program to other

vaccines - shingles is a possibility - at a nominal fee.

Framingham is considering a similar proposal, and has applied to drug companies

for free vaccine, such as a Merck program offering doses for human

papillomavirus, or HPV. While HPV is the most common sexually transmitted

disease, public supply can no longer go to women over 18.

Mahoney is surveying medical offices in town to see which vaccines they carry,

and trying to educate providers. Given that hepatitis A comes as a series of two

doses and hepatitis A as a series of three, she's also hatched a plan for her

limited supply: give the first shot, then get the visitor signed up for health

insurance and a doctor for the remainder.

" There are some ways we could try to stretch this out, " Mahoney said. " But I'm

not sure what we'll do. "

( Morton can be reached at 508-626-4338 or mmorton@....)

Copyright 2011 The MetroWest Daily News. Some rights reserved

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