The Pharmaceutical Journal
Vol 273 No 7322 p598-599
23 October 2004

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Health services

US health system is catching a cold

From Ms R. A. Elliott, MRPharmS

Here in the US, the big health news story is the UK Medicines and Healthcare products Regulatory Agency withdrawal of Chiron’s licence so their influenza vaccine, Fluvirin, is not available for this winter. Chiron provides 20 per cent of UK supply, but it provides 50 per cent of US supply (48 million doses). The news coverage here has had US clinicians expressing shock at this UK action. Serratia was discovered in the vaccine strain this summer so withdrawal was not completely unexpected. There are news bulletins and signs at pharmacies that there will be a shortage and that only people in most need should get vaccinated (as happens in the UK already). It appears that everyone who believed they needed a vaccine in the past could have it (if they could afford it). Needs-based health care is much less alien to a British person than to an American, so this is a great departure for ordinary people here.

What no one seems to be asking here in the US is why a country of 280 million people relies on only two influenza vaccine suppliers, at least one of which is not domestic. As a pharmacist I find this lack of supply chain insight incompetent and shortsighted. As a health economist the answer is simpler. The private market for health care in the US does not support vaccine production, which is a costly and unpredictable business. If there is no influenza epidemic, no one wants the vaccine so it has to be destroyed. However, the company has to rely on epidemic predictions and make the vaccine in advance due to the manufacturing process and volumes required, therefore, it is a risky business.

George W. Bush accuses John Kerry of wanting a Government-run health system and warns that this will lead to rationing, and reductions in quality and choice. This contrasts with the current system of a free market for health care that leaves 48 million Americans with no coverage at all and a system unable to support a reliable domestic supply of influenza vaccine, an inexpensive effective intervention.

The vaccine situation in the US demonstrates clearly market failure in health care and further supports the case against a free market. We may have more explicit rationing in the UK NHS, but our constant struggle to provide equitable universal health care through taxation leads me to think that the NHS is the healthier organism.

Rachel Elliott
Harvard Medical School
Boston, Massachusetts

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