Douglas County health officials are delaying some childhood vaccinations and reducing doses of others because of a global shortage one state official said could undermine Kansas’ long-running public immunization program.

“It is threatening to destabilize an effort that’s been very successful to this point,” said Mike Heideman, spokesman for the Kansas Department of Health and Environment.

The program, Heideman said, “is one of the core efforts of public health.”

Elaine Houston, immunization coordinator for the Lawrence-Douglas County Health Department, said public health isn’t in immediate danger.

“At this point, spreading out (doses) won’t be a problem,” she said. “Hopefully, the manufacturers will get back online.”

The Douglas County shortage is most severe in three types of vaccines:

l Tetanus-diptheria, which is usually given to children between the ages of 11 and 14. Houston said those scheduled shots are being deferred so the vaccine can be given as “wound management” for injured adults who haven’t received recent tetanus shots.

l Diphtheria-tetanus-pertussis, which is typically administered in five doses to children by the time they reach 5 years old. Houston said the department is reducing that to four doses; three in infancy.

l Prevnar, a relatively new vaccine that prevents meningitis in infants. It is usually given in four doses  the health department has reduced that to two doses.

Health officials said the reduced number of doses still create a measure of protection for children, although not as strong as the full series.

Houston said shortages for Varicella (a chicken pox vaccine) and a measles-mumps-rubella shot are also expected.

“The only vaccine we’re not short of at this point is the polio vaccine,” Heideman said.

A problem of global scale

The childhood vaccine shortage is on its way to becoming a global problem. UNICEF last week announced that its immunization programs were endangered.

“These shortages affect virtually every category of traditional vaccine given to children in poor countries,” said Carol Bellamy, UNICEF’s executive director. “Similar shortages are also occurring in the industrialized world.”

She said 10 of 14 vaccine manufacturers reduced or halted childhood vaccine production between 1998 and 2001 because of market pressures to produce newer, more profitable products.

Jeff Trewhitt, a spokesman for the Pharmaceutical Manufacturers of America, wouldn’t comment on specific shortages, saying individual companies should be contacted.

But he said that product-liability concerns thinned the ranks of pharmaceutical companies worldwide from 30 in the 1960s to just four now. Expensive production costs make it hard for companies to justify making some vaccines.

“It’s hard to get an adequate, sound return on an investment,” Trewhitt said. “Many or most of the customers are government agencies who are paying low, cost-controlled prices.”

The state provides the vaccines to local health departments. Heideman said KDHE has changed the vaccine-order process from quarterly to monthly, and the formerly unlimited bulk orders are now restricted to the size of each county’s average monthly use.

KDHE is also recommending the local health departments start a “callback list” so that children who have been started on a series of doses are the first to receive the follow-up shots.

“That way we can complete the series instead of hit or miss,” Heideman said.

Houston said local parents have been concerned by the shortage.

“It’s hard for people to understand why they can’t get the shots when they’re told they’re important,” she said. “And they don’t understand why they can’t get the whole series of boosters when it takes the whole series to get good protection.”