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Gary L. Freed, MD, MPH; Matthew M. Davis, MD, MAPP; Sarah J. Clark, MPH

JAMA. 2003;289:575-578.

Context  In late August 2001, a serious shortage of the heptavalent pneumococcal conjugate vaccine (PCV7) developed in 34 state immunization programs. In September 2001, the Centers for Disease Control and Prevention published revised recommendations advising physicians to prioritize PCV7 to specific groups of children. The effect of the shortage at the practice level is unknown.

Objective  To determine the variation between public and private markets in the supply of PCV7 and the nature and extent of the PCV7 shortage at the practice level.

Design, Setting, and Participants  Semistructured interviews with office staff responsible for ordering vaccines at private practices in 12 states were conducted between October 19 and November 2, 2001.

Main Outcome Measures  Variation in supply of PCV7 obtained from public sources and through purchase on the private market. Supply was characterized into 3 categories: "no problem," "problem obtaining a consistent supply," and "out of stock."

Results  Interviews were completed at 405 practices, representing a response rate of 74%. Overall, 51% of practices reported at least 1 episode of being out of stock of public PCV7 and 64% of private PCV7, with significant state-to-state variation. Only 2 of 12 study states had a substantially higher proportion of practices experiencing out-of-stock episodes for public compared with private PCV7, while in 6 states public PCV7 was less frequently out of stock than private PCV7. Only 23% of practices in this study altered their administration policy for private PCV7, while 27% altered their policy for public PCV7.

Conclusions  The distribution and supply of PCV7 varied between public and private supplies and between states during the shortage. Few practices changed their administration schedules in response to revised recommendations.

Author Affiliations: Child Health Evaluation and Research Unit, Division of General Pediatrics (Drs Freed and Davis and Ms Clark), and Division of General Internal Medicine (Dr Davis), University of Michigan, Ann Arbor.

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