The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the editor

Editor, – Having just read the interesting editorial'H1N1 immunisation: too much too soon?' (Aust Prescr 2010;33:30-1) by Peter Collignon, it would be evident that considerable waste took place in the delivery of the vaccine to the patient. Not only in the use of multi dose vials, but in the waste of the unused vials which now have to be discarded with the introduction of the new 2010 trivalent influenza vaccine. I wonder if details of the wastage and relevant costs are available.

I understand that CSL developed the swine flu vaccine and delivered the vials to the Commonwealth Health Department. Was CSL paid by the Government for the vaccines or did CSL bear the loss?

As Deputy Chair of the Return Unwanted Medicines Project, I would also be interested to know how the unused vaccine vials are to be destroyed I hope it is in an environmentally responsible manner!

Ken Bickle
Pharmacist
Greenwich, NSW

Author's comments

Professor Peter Collignon, author of the editorial, comments:

I agree with Ken Bickle that considerable waste was associated with the H1N1 immunisation program. Full details are not readily available because of 'commercial in confidence' agreements. From media reports it appears that CSL received about $120 million from our Federal Government for 21 million vaccine doses.1 An added potential cost to the Government is the indemnity CSL received for any serious adverse events resulting from the vaccine.

Only a quarter of these doses were distributed1and the vaccine was presented in multi dose vials. Multi dose vials result in much higher vaccine wastage compared to single-use preloaded syringes.2 I suspect that 30% of the distributed vaccine doses were never administered. Additionally, most of the vaccine given was to those over 65 years.3 This age group already had high levels of pre-existing immunity to H1N1 (swine flu) and thus vaccination was not likely to have been much benefit for them.

The World Health Organization has documented the major infection problems associated with unsafe injection practices.4 This results in millions of viral and bacterial infections every year, especially in developing countries.5 Multi dose vials and immunisation practices may only be a small component of this problem, but this risk can be virtually eliminated with the use of preloaded single-use syringes for vaccination (which we use for seasonal flu vaccinations here). Using single-use preloaded syringes also results in considerably less wastage of vaccine.2 This reduced wastage will usually more than compensate for their small additional cost (about 14 cents).2

Multi dose vials may sometimes have a place for the delivery of inexpensive vaccines in countries with low resources and poor infrastructure.2 They have no place in a country such as Australia.

References

  1. Dayton L, Franklin M. Nicole Roxon in flu vaccine dilemma. The Australian. 2010 Jan 7.www.theaustralian.com.au/news/nation/nicole-roxonin-flu-vaccine-dilemma/story-e6frg6nf-1225816777813 [cited 2010 May 3]
  2. Drain PK, Nelson CM, Lloyd JS. Single-dose versus multi-dose vaccine vials for immunization programmes in developing countries. Bull World Health Organ 2003;81:726-31.
  3. Australian Institute of Health and Welfare. 2009 Adult vaccination survey. Provisional topline results for H1N1 vaccination uptake.www.aihw.gov.au [ cited 2010 May 11]
  4. Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of blood borne pathogens: a review. Bull World Health Organ 1999;77:789-800.
  5. Kane A, Lloyd J, Zaffran M, Simonsen L, Kane M. Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates. Bull World Health Organ 1999;77:801-7.