We think that Dr Tim Blackmore has accurately described the issues around the interruption to New Zealand’s influenza vaccine supply earlier this year (http://www.nzma.org.nz/journal/118-1219/1596/).

As Dr Blackmore states, New Zealand has had a single supplier for subsidised influenza vaccine for the past 8 years. PHARMAC has now undertaken a formal review of influenza vaccine purchasing, in the wake of this year’s experience*. As a result of this review, New Zealand will have more than one supplier for subsidised influenza vaccine from 2006 onwards.

We are confident that Sanofi Pasteur, the world’s largest manufacturer of influenza vaccines, is a reliable supplier. However, due to the complexities of vaccine manufacture, we now agree that it is wise to have at least one other supplier. For this reason, we will have at least two companies supplying subsidised influenza vaccines in New Zealand, as was intended in Australia this year. Sanofi Pasteur will be one of those suppliers, with others yet to be confirmed.

Despite the confusion and delays, our monitoring to date indicates that the uptake of subsidised influenza vaccine has been higher than last year. We understand that there was a similar increase in the uptake of influenza vaccine in the United States (of up to 15% in some patient groups) following similar supply issues there with consequent adverse publicity. Increased uptake of course does not justify the very real public anxiety around the vaccine supply this year.

With New Zealand’s small market, a dual or multiple supply arrangement will inevitably result in higher prices being paid for the vaccines. While multiple supply reduces the risk of having no vaccine, it does not remove that risk; Dr Blackmore correctly indicates that prioritisation of any available vaccine would still be required should one supplier fail to deliver their vaccine.

Sole supply itself is not inherently flawed. Influenza vaccines are complex substances to manufacture, and time constraints mean that if there are problems with a particular brand then this is difficult to redress in time for the winter influenza season. This does not occur for most pharmaceutical agents, and it is worth remembering that all on-patent medicines are essentially sole supply. PHARMAC considers that tendering for off-patent medicines is an effective way to secure the supply of pharmaceutical agents and to achieve lower prices for generic medicines.

Andrea Dick
Hospital Pharmaceutical Contracts Manager
PHARMAC
Wellington