The Impact of the 2004–2005 Influenza Vaccine Shortage
in the Veterans Health Administration
Leila C. Kahwati, MD, MPH
, John R. Elter, DMD, PhD
, Kristy A. Straits-Tröster, PhD
Linda S. Kinsinger, MD, MPH
, and Victoria J. Davey, RN, MPH
National Center for Health Promotion and Disease Prevention, Office of Patient Care Services, Veterans Health Administration, Department
of Veterans Affairs, 3022 Croasdaile Dr. Suite 200, Durham, North Carolina 27705, USA;
Office of Quality and Performance, Veterans
Health Administration, Department of Veterans Affairs, Durham, North Carolina 27705, USA;
Mid-Atlantic Network Mental Illness Research
Education and Clinical Center, Veterans Health Administration, Department of Veterans Affairs, Durham, North Carolina 27705, USA;
Office of Public Health and Environmental Hazards, Veterans Health Administration, Department of Veterans Affairs, Washington, DC,
BACKGROUND: The Veterans Health Administration
(VHA) serves a population at high risk of influenza-
related morbidity and mortality. The national public
health response to the vaccine shortage of the 2004–
2005 season resulted in prioritization of recipients and
redistribution of available supply.
OBJECTIVE: To characterize the impact of the 2004–
2005 influenza vaccine shortage on vaccination among
users of VHA facilities.
DESIGN: Analysis using data from the cross-sectional
VHA Survey of Healthcare Experiences of Patients.
PARTICIPANTS: Outpatients seen in VHA clinics dur-
ing the months September 2004–March 2005.
MEASUREMENTS: Sociodemographics, vaccination
prevalence, setting of vaccination, and reasons cited
for not getting vaccinated.
RESULTS: Influenza vaccination prevalence among
VHA outpatients aged 50–64 was 56% and for those
aged ≥65 was 86%. Compared to the 2 previous
seasons, this estimate was lower for patients age 50–
64 but similar for patients ≥65. After adjustment for
patient characteristics, unvaccinated patients aged 50–
64 were 8.3 (95% CI 6.0, 11.4) times as likely to cite that
they were told they were not eligible for vaccination
because of the national shortage compared to patients
≥65. Regional VHA variation in vaccination receipt and
shortage-related reasons for nonvaccination was small.
CONCLUSIONS: The national influenza vaccine short-
age of 2004–2005 primarily affected VHA users aged
50–64, consistent with the tiered prioritization guid-
ance issued by the Centers for Disease Control and
Prevention and Advisory Committee on Immunization
Practices. Despite the shortage, vaccination prevalence
among VHA users ≥65 remained high.
KEY WORDS: influenza vaccine; veteran; vaccine shortage.
© 2007 Society of General Internal Medicine 2007;22:1132–1138
In 2004–2005, the United States (U.S.) suffered a shortage of
influenza vaccine primarily because of the license suspension
in October 2004 of Chiron Corporation by the United King-
dom’s Medicines and Healthcare Products Regulatory Agency.
At the time, Chiron was anticipated to supply almost half of the
estimated 100 million doses required in the U.S. for the 2004–
2005 influenza season.
The Centers for Disease Control and
Prevention (CDC), in coordination with the Advisory Commit-
tee for Immunization Practices (ACIP), rapidly responded to
news of the impending shortage by recommending priority
groups of patients to receive vaccine that would be available
from the only other FDA-approved manufacturer of inactivated
influenza vaccine, Aventis Pasteur, Inc (now Sanofi Pasteur).
In conjunction with state health departments, the CDC also
began coordinating nationwide tracking of vaccine demand
and supply to reallocate available doses where needed. In the
U.S., this task is made difficult because many people get
vaccinated in nongovernmental settings such as private health
care offices/systems, work settings, and nonclinical commu-
nity settings (grocery stores, senior centers, etc.).
The Veterans Health Administration (VHA) is the nation’s
largest integrated health care system, and as of June 2005
operated approximately 157 medical centers, 862 community-
based outpatient clinics, 134 nursing homes, and 337 other
types of facilities and programs.
More than 5 million patients
received care in VHA facilities in 2004 and VHA outpatient
clinics registered nearly 54 million visits. Whereas many
operations within VHA are delegated to the 21 regionally
situated Veterans Integrated Service Networks (VISNs), some
functions are retained centrally by VHA, including medication
and vaccine procurement. Over the last several influenza
seasons, VHA has increased the amount of inactivated influ-
enza vaccine purchased for administration to beneficiaries and
employees buying 1.58 million doses in 2002, 2.05 million in
2003, 2.10 million in 2004, and 2.49 million in 2005.
Received November 22, 2006
Revised April 18, 2007
Accepted May 2, 2007
Published online June 2, 2007