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Archive for Monday, November 15, 2004

The politics of flu shots

November 15, 2004

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— Toward the end of the campaign, President Bush offered his small variation on JFK's famous line: Ask not what your country can do for you, ask what you can not do for your country.

"My call to our fellow Americans is, if you're healthy, if you're younger, don't get a flu shot this year."

I have followed the patriotic edict to go unarmed into this flu season. In fact, unlike certain members of the Congress who shall remain nameless, I have no choice but to follow it.

At the same time, I have been collecting various little anecdotes for The Flu Story 2004.

First is the tale of a New York friend who had to go to Toronto for work. She found the name of a doctor through the Canadian sister of a friend of a friend. Then, feeling vaguely like a mule in some illegal drug operation, she got her shot, wrapped the rest of the vial in ice and smuggled it back to her stateside doctor for distribution to seven high-risk patients.

There is another friend, a certified member of the greatest generation living in the capital of the free world, who ended up at 5:30 one morning in a drug-store line in search of a shot.

Then there is a department store Santa Claus, 62-year-old Nick Pallotto of Denver, who couldn't get the vaccine despite the fact that about 10,000 children will pass across his lap.

And there are assorted elders in New Jersey who celebrated their vaccinations as if they'd won the lottery. In fact, they had won a lottery.

If we are lucky, if the flu season is mild and the crick don't rise, this may not be a disaster. But for the moment, we have the Centers for Disease Control and Prevention rationing the last 10 million doses and we have New York City independently ordering its own vaccine from Europe.

In short, every American is getting a chance to see what life's like for people without health care insurance and just how precarious the health care system really is.

The strain of flu that is coming our way has been dubbed by one reporter as the Free Market Flu. This shortage is not, after all, a natural phenomenon, like say, a shortage in pomegranates or pineapples. The world did not run out of the chicken eggs whence the vaccine cometh.

The entire debacle comes from the fact that preventing the flu isn't as profitable as, say, treating erectile dysfunction. The major American drug companies, who continuously tell us that their profits are for our benefit, don't do flu vaccines anymore.

For some years, flu prevention has been outsourced without oversight. Chiron Corp., one of the vaccine manufacturers, had worried the FDA as long ago as 1999, but it was the Brits who blew the whistle on them in October when this year's batch of vaccines was contaminated. We were left dependent -- mon dieu! -- on a French company, Aventis Pasteur.

As James Morone, a political scientist at Brown University and co-author of the upcoming "Healthy, Wealthy and Fair," says, "When one company in England runs into trouble, the whole thing collapses. Private markets are only as good as the public health system overseeing them. If there were a sudden run on watches or sofas it wouldn't be a problem, but health care can't work that way."

Instead of sofas and watches, it might be life and death. About 36,000 people died from the flu last year and that was when vaccine was available. After 9-11 with all the talk of bioterrorism, anthrax and smallpox, there was the beginning of a dialogue about strengthening the public health system. But today we rarely talk about the basics, like vaccines, as a public good.

Americans have long been told that national health care would mean long lines, rationing and second-class medicine. Despite spending more of our gross national product on health care than any other country, we rank 29th in life expectancy, right between Slovenia and Portugal. And what do we have? Long lines and rationing. Not to mention lotteries, and a shot in the arm for Canadian tourism.

Maybe it takes the Free Market Flu to remind us that sometimes we need a public health system as much as we need a fire department or a military. For the moment, however, a casino in Las Vegas has generously donated its 5,000 doses to the local health department. A retirement home has given the Denver Santa his shot.

Meanwhile back home, I think I will tie a patriotic yellow ribbon around a great big pot of chicken soup.

-- Ellen Goodman is a columnist for Washington Post Writers Group.

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