United States Government Accountability Office

GAO Testimony

Before the Committee on Government

Reform, House of Representatives 

INFLUENZA PANDEMIC

Applying Lessons Learned 

from the 2004–05 Influenza 

Vaccine Shortage 

Statement for the Record by Marcia Crosse 

Director, Health Care

For Release on Delivery 

Expected at 10:00 a.m. EST 

Friday, November 4, 2005 

 

GAO-06-221T
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

November 4, 2005

INFLUENZA PANDEMIC

Applying Lessons Learned from the 

Highlights of GAO-06-221T, a statement 2004–05 Influenza Vaccine Shortage

for the record for the Committee on

Government Reform, House of

Representatives

Concern has been rising about the

nation’s preparedness to respond 

to vaccine shortages that could

occur in future annual influenza

seasons or during an influenza

pandemic—a global influenza

outbreak. Although the timing or 

extent of a future influenza 

pandemic cannot be predicted, 

studies suggest that its effect in the 

United States could be severe, and 

shortages of vaccine could occur.

For the 2004–05 annual influenza 

season, the nation lost about half

its expected influenza vaccine

supply when one of two major 

manufacturers announced in 

October 2004 that it would not

release any vaccine. GAO 

examined federal, state, and local

actions taken in response to the

shortage, including lessons learned.

The nation’s experience during the

unexpected 2004–05 vaccine

shortfall offers insights into some

of the challenges that government

entities will face in a pandemic.

GAO was asked to provide a

statement on lessons learned from 

the 2004–05 vaccine shortage and

their relevance to planning and

preparing for similar situations in

the future, including an influenza

pandemic. This statement is based 

on a GAO report, Influenza

Vaccine: Shortages in 2004–05 

Season Underscore Need for Better 

Preparation (GAO-05-984), and on

previous GAO reports and 

testimonies about influenza

vaccine supply and pandemic 

preparedness. 

A number of lessons emerged from federal, state, and local responses to the 

2004–05 influenza vaccine shortage that carry implications for handling 

future vaccine shortages in either an annual influenza season or an influenza 

pandemic. 

• First, limited contingency planning slows response. At the start of the 

2004–05 influenza season, when the supply shortfall became apparent, 

the nation lacked a contingency plan specifically to address severe

shortages. The absence of such a plan led to delays and uncertainties on

the part of state and local public health entities on how best to ensure 

access to vaccine by individuals at high risk of severe influenza-related 

complications. 

• Second, streamlined mechanisms to expedite vaccine availability are key 

to an effective response. During the 2004–05 shortage, for example, 

federal purchases of vaccine licensed for use in other countries but not 

the United States were not completed in time to meet peak demand. 

Some states’ experience also highlighted the importance of mechanisms 

to transfer available vaccine quickly and easily from one state to another.

• Third, effective response requires clear and consistent communication. 

Consistency among federal, state, and local communications is critical

for averting confusion. State and local health officials also emphasized 

the value of updated information when responding to changing 

circumstances, using diverse media to reach diverse audiences, and 

educating providers and the public about prevention alternatives. 

Over the past 5 years, GAO has urged the Department of Health and Human 

Services (HHS) to complete its plan to prepare for and respond to an 

influenza pandemic. GAO has reported on the importance of planning to 

address critical issues such as how vaccine will be purchased and 

distributed; how population groups will be given priority for vaccination; and 

how federal resources should be deployed before the nation faces a 

pandemic. On November 2, 2005, HHS released its pandemic influenza plan. 

GAO did not have the opportunity to review the plan before issuing this

statement to determine the extent to which the plan addresses these critical

issues. 

www.gao.gov/cgi-bin/getrpt?GAO-06-221T.

To view the full product, including the scope 

and methodology, click on the link above.

For more information, contact Marcia Crosse

at (202) 512-7119 or crossem@gao.gov.
Mr. Chairman and Members of the Committee: 

I am pleased to have the opportunity to provide information on our recent 

review of the 2004–05 influenza vaccine shortage, with lessons to consider

as the nation improves its ability to respond to an influenza pandemic (a

global influenza outbreak resulting from a major genetic change in the 

influenza virus).1

 Concern about the nation’s preparedness to respond to

an influenza pandemic has been growing for some time, in part because of 

the increase in the number of identified human cases of avian influenza in 

Asia.

2

 Studies suggest that a pandemic’s effects in the United States could 

be severe, and shortages of vaccine could occur. The nation’s experience 

responding to the shortage of annual influenza vaccine for the 2004–05 

influenza season—in which the nation faced an unexpected loss of nearly

half its projected vaccine supply—offers insight into the some of the 

challenges that federal, state, and local entities will face if a pandemic 

occurs. 

My statement includes findings from our recent report on last winter’s

influenza vaccine shortage and discusses lessons learned from that

experience that could help prepare the nation to respond to future vaccine 

shortages in either an annual influenza season or an influenza pandemic.3

My statement also draws from several GAO reports and testimonies on

influenza vaccine supply, pandemic planning, and emergency 

preparedness for emerging infectious diseases that we have issued since 

October 2000.4

 This body of work includes interviews with officials in the 

Department of Health and Human Services (HHS), such as officials from

 1

An influenza pandemic is defined by the emergence of a novel influenza virus, to which 

much or all of the population is susceptible, that is readily transmitted person to person

and causes outbreaks in multiple countries. Among the most notorious 20th-century 

outbreaks was the “Spanish influenza” of 1918, which is estimated to have killed 500,000 or 

more people in the United States and 40–50 million people worldwide.

2

Since December 2003, 122 confirmed avian influenza cases in humans have been reported

to the World Health Organization (WHO); these cases have occurred in four countries, and 

about half the victims died. See World Health Organization, “Cumulative Number of 

Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO,”

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_11_01/en

/index.html, downloaded Nov.1, 2005. Avian influenza has also been confirmed in birds in

Europe. 

3

GAO, Influenza Vaccine: Shortages in 2004–05 Season Underscore Need for Better 

Preparation, GAO-05-984 (Washington, D.C.: Sept. 30, 2005). 

4

See “Related GAO Products” at the end of this testimony. 

Page 1 GAO-06-221T
the Centers for Disease Control and Prevention (CDC) and the National

Vaccine Program Office. For the report on the 2004–05 influenza vaccine 

shortage, we conducted site visits at a sample of states and localities.5

 We 

also interviewed officials from public health departments and a major 

influenza vaccine manufacturer; national organizations, including the 

Association of State and Territorial Health Officials and the Association of

Immunization Managers; organizations that conduct mass immunization 

clinics; and a large purchaser of influenza vaccine. We conducted all of our 

work in accordance with generally accepted government auditing 

standards. 

In summary, a number of lessons emerged from federal, state, and local 

responses to the 2004–05 influenza vaccine shortage that carry 

implications for handling future vaccine shortages in either an annual 

influenza season or an influenza pandemic. First, limited contingency 

planning slows response. At the start of the 2004–05 influenza season, 

when the nation unexpectedly lost roughly half its projected influenza 

vaccine supply, the nation lacked a contingency plan specifically for a 

severe vaccine shortage. The absence of such a plan led to delays and 

uncertainties on the part of state and local public health entities on how

best to ensure access to vaccine by individuals at high risk of severe 

influenza-related complications. Since 2000, we have encouraged the

development of a plan to address critical issues that could arise in an 

influenza pandemic. Second, streamlined mechanisms to expedite vaccine 

availability are key to an effective response. During the 2004–05 shortage, 

for example, federal purchases of vaccine licensed for use in other 

countries but not the United States were not completed in time to meet

peak demand. Some states’ experience also highlighted the importance of

mechanisms to transfer available vaccine quickly and easily from one state

to another. Third, effective response requires clear and consistent

communication. Consistency among federal, state, and local

communications is critical for averting confusion. State and local health 

officials also emphasized the value of updated information when 

responding to changing circumstances, using diverse media to reach 

diverse audiences, and educating providers and the public about

prevention alternatives. 

 5

The states were California, Florida, Maine, Minnesota, and Washington, and the localities

were San Diego and San Francisco, California; Miami-Dade County, Florida; Portland,

Maine; Stearns County, Minnesota; and Seattle–King County, Washington. We selected 

these states and localities on the basis of geography, population size, and state vaccination

success rates.

Page 2 GAO-06-221T
Background Influenza is more severe than some viral respiratory infections, such as the 

common cold. During an annual influenza season, most people who 

contract influenza recover completely in 1 to 2 weeks, but some develop 

serious and potentially life-threatening medical complications, such as

pneumonia. People aged 65 years and older, people of any age with 

chronic medical conditions, children younger than 2 years, and pregnant 

women are generally more likely than others to develop severe 

complications from influenza. In an average year in the United States, 

more than 36,000 individuals die and more than 200,000 are hospitalized 

from influenza and related complications. 

Pandemic influenza differs from annual influenza in several ways. 

According to the World Health Organization, pandemic influenza spreads 

to all parts of the world very quickly, usually in less than a year, and can 

sicken more than a quarter of the global population, including young, 

healthy individuals. Although health experts cannot predict with certainty 

which strain of influenza virus will be involved in the next pandemic, they 

warn that the avian influenza virus identified in the human cases in Asia, 

known as H5N1, could lead to a pandemic if it acquires the genetic ability, 

so far absent, to spread quickly from person to person. 

Vaccination is the primary method for preventing influenza and its 

complications. Produced in a complex process that involves growing

viruses in millions of fertilized chicken eggs, influenza vaccine is 

administered each year to protect against particular influenza strains 

expected to be prevalent that year. Experience has shown that vaccine 

production generally takes 6 or more months after a virus strain has been 

identified; vaccines for certain influenza strains have been difficult to 

mass-produce. After vaccination for the annual influenza season, it takes 

about 2 weeks for the body to produce the antibodies that protect against

infection. According to CDC recommendations, the optimal time for 

annual vaccination is October through November. Because the annual 

influenza season typically does not peak until January or February, 

however, in most years vaccination in December or later can still be 

beneficial. 

At present, two vaccine types are recommended for protection against

influenza in the United States: an inactivated virus vaccine injected into 

muscle and a live virus vaccine administered as a nasal spray. The 

injectable vaccine—which represents the large majority of influenza 

vaccine administered in this country—can be used to immunize both 

healthy individuals and individuals at highest risk for severe 

complications, including those with chronic illness and those aged 65 

Page 3 GAO-06-221T
years and older. The nasal spray vaccine, in contrast, is currently approved 

for use only among healthy individuals aged 5 to 49 years who are not 

pregnant. For the 2003–04 influenza season, two manufacturers—one with

production facilities in the United States (sanofi pasteur6) and one with

production facilities in the United Kingdom (Chiron)—produced about 83 

million doses of injectable vaccine, which represented about 96 percent of

the U.S. vaccine supply. A third U.S. manufacturer (MedImmune) 

produced the nasal spray vaccine.

7

 For the 2004–05 influenza season, CDC 

and its Advisory Committee on Immunization Practices (ACIP) initially 

recommended vaccination for about 188 million people in designated 

priority groups, including roughly 85 million people at high risk for severe 

complications.8

 On October 5, 2004, however, Chiron announced that it 

could not provide its expected production of 46–48 million doses—about 

half the expected U.S. influenza vaccine supply. 

Although vaccination is the primary strategy for protecting individuals 

who are at greatest risk of severe complications and death from influenza, 

antiviral drugs can also help to treat infection. If taken within 2 days of a 

person’s becoming ill, these drugs can ease symptoms and reduce 

contagion. In the event of a pandemic, such drugs could lower the number

of deaths until a pandemic influenza vaccine became available. Four

antiviral drugs have been approved by the Food and Drug Administration

(FDA) for treatment of influenza: amantadine, rimantadine, oseltamivir, 

and zanamivir.9

HHS has primary responsibility for coordinating the nation’s response to

public health emergencies. Within HHS, CDC is one of the agencies that

 6

The company spells its name without capital letters.

7

Another injectable influenza vaccine for adults, produced by GlaxoSmithKline Biologicals,

based in Belgium, was approved and licensed by FDA on August 31, 2005, for the U.S.

market. The company expects to produce about 8 million doses for the 2005–06 influenza 

season. 

8

Not everyone in target populations receives a vaccination each year. For example, CDC

reported that in 2003 an estimated 66 percent of people aged 65 years and older received an

influenza vaccination. See Centers for Disease Control and Prevention, “Prevention and 

Control of Influenza: Recommendations of the Advisory Committee on Immunization

Practices (ACIP),” Morbidity and Mortality Weekly Report, vol. 54, no. RR-8 (2004), 1–40. 

9

According to CDC, the H5N1 avian influenza virus is resistant to amantadine and 

rimantadine, commonly used for influenza; oseltamivir and zanamivir would probably work

to treat influenza caused by the H5N1 virus, but additional studies are still needed to prove

their effectiveness.

Page 4 GAO-06-221T
protect the nation’s health and safety. CDC’s activities include efforts to

prevent and control diseases and to respond to public health emergencies. 

CDC and ACIP recommend which population groups should be targeted 

for vaccination each year and, when vaccine supply allows, recommend 

that any person who wishes to decrease his or her risk of influenza be 

vaccinated.10 In addition, the National Vaccine Program Office is

responsible for coordinating and ensuring collaboration among the many 

federal agencies involved in vaccine and immunization activities; the office 

also issued a draft national pandemic influenza preparedness plan in

August 2004.11

Preparing for and responding to an influenza pandemic differ in several 

respects from preparing for and responding to an annual influenza season. 

For example, past influenza pandemics have affected healthy young adults

who are not typically at high risk for severe influenza-related 

complications, so the groups given priority for early vaccination may differ 

from those given priority in an annual influenza season. In addition, 

according to CDC, a vaccine probably would not be available in the early

stages of a pandemic. Shortages of vaccine would therefore be likely

during a pandemic, potentially creating a situation more challenging than a 

shortage of vaccine for an annual influenza season. 

One lesson learned from the 2004–05 season that is relevant to a future 

vaccine shortage in either an annual influenza season or a pandemic is the 

importance of planning before a shortage occurs. At the time the influenza 

vaccine shortage became apparent, the nation lacked a contingency plan 

specifically designed to respond to a severe vaccine shortage. The absence

of such a plan led to delays and uncertainty on the part of many state and 

local entities on how best to ensure access to vaccine during the shortage

by individuals at high risk of severe complications and others in priority

groups. Faced with the unanticipated shortfall, CDC redefined the priority

Limited Contingency 

Planning Slows

Response 

 10In addition, FDA plays a role in preparing for annual influenza seasons and a potential

pandemic in approving and regulating use of vaccines and drugs, including antiviral 

medications. FDA also develops influenza reference strains and reagents and makes them

available to manufacturers for vaccine development and evaluation. 

11Department of Health and Human Services, National Vaccine Program Office, Draft 

Pandemic Influenza Preparedness and Response Plan (Washington, D.C.: August 2004). 

Page 5 GAO-06-221T
groups it had recommended for vaccination12 and asked sanofi pasteur, the 

remaining manufacturer of injectable vaccine, to suspend distribution until 

the agency completed its assessment of the shortage’s extent and 

developed a plan to distribute the manufacturer’s remaining vaccine to 

providers serving individuals in the priority groups. Developing and 

implementing this distribution plan took time and led to delays in response 

and some confusion at state and local levels. 

Our work showed that several areas of planning are particularly important

for enhancing preparedness before a similar situation occurs in the future, 

including defining the responsibilities of federal, state, and local officials; 

using emergency preparedness plans and emergency health directives; and 

facilitating the distribution and administration of vaccine. 

• Clearly defining responsibilities of federal, state, and local officials can 

minimize confusion. During the 2004–05 vaccine shortage, even though 

CDC worked with states and localities to coordinate roles and 

responsibilities, problems occurred. For example, CDC worked with

national professional associations to survey long-term-care providers

throughout the country to determine if seniors had adequate access to 

vaccine. Maine and other states, however, also surveyed their long-termcare providers to make the same determination. This duplication of effort

expended additional resources, burdened some long-term-care providers 

in the states, and created confusion.13

• Emergency preparedness plans help coordinate local response. State and 

local health officials in several locations we visited reported that using 

existing emergency plans or incident command centers (the organizational

systems set up specifically to handle the response to emergency

situations) helped coordinate effective local responses to the vaccine

shortage. For example, public health officials from Seattle–King County 

said that using the county’s incident command system played a vital role in

coordinating an effective and timely local response and in communicating

a clear message to the public and providers. In addition, according to 

 12These revised recommendations decreased the number of people in groups recommended

for vaccination by about half, from about 188 million to about 98 million. See Centers for

Disease Control and Prevention, “Interim Influenza Vaccination Recommendations, 2004–

05 Influenza Season,” Morbidity and Mortality Weekly Report, vol. 53, no. 39 (2004), 923–

924. 

13After the 2004–05 influenza season, CDC reviewed its response to the vaccine shortage

and took a number of steps, including issuing interim guidelines in August 2005 to assist in

responding to possible future shortages.

Page 6 GAO-06-221T
public health officials, emergency public health directives helped ensure 

access to vaccine by supporting providers in enforcing the CDC 

recommendations and in helping to prevent price gouging in certain states.

• Partnerships between the public and private sectors can facilitate

distribution and administration of vaccine. In San Diego County,

California, for example, local health officials worked with a coalition of 

partners in public health, private businesses, and nonprofit groups 

throughout the county. Other mechanisms facilitated administering the 

limited supply of influenza vaccine to those in high-risk or other priority 

groups. In Stearns County, Minnesota, for example, public health officials 

worked with private providers to implement a system of vaccination by 

appointment. Rather than standing in long lines for vaccination, 

individuals with appointments went to a clinic during a given time slot. 

Although an influenza pandemic may differ in some ways from an annual

influenza season, experience during the 2004–05 shortage illustrated the 

importance of having contingency plans in place ahead of time to prevent 

delays when timing is critical. Some health officials indicated that, as a 

result of the experience with the influenza vaccine shortage, they were 

revising state and local preparedness plans or modifying command center 

protocols to prepare for future emergencies. For example, experiences 

during the 2004–05 influenza season led Maine state officials to recognize 

the need to speed completion of their pandemic influenza preparedness 

plan. 

Over the past 5 years, we have reported on the importance of planning to 

address critical issues such as how vaccine will be purchased and 

distributed; how population groups will be given priority for vaccination; 

and how federal resources should be deployed before the nation faces a 

pandemic. We have also urged HHS to complete its pandemic 

preparedness and response plan, which the department released in draft

form in August 2004. This draft plan described options for vaccine 

purchase and distribution and provided planning guidance to state and 

local health departments. As we testified earlier, however, the draft plan 

lacked clear guidance on potential priority groups for vaccination in a 

pandemic, and key questions remained about the federal role in

purchasing and distributing vaccine.

14 The experience in 2004–05 also 

highlighted the importance of finalizing such planning details. On 

 14See GAO, Influenza Pandemic: Challenges in Preparedness and Response, GAO-05-863T 

(Washington, D.C.: June 30, 2005). 

Page 7 GAO-06-221T
November 2, 2005, HHS released its pandemic influenza plan. We did not, 

however, have an opportunity to review the plan before issuing this

statement to determine whether the plan addresses these critical issues. 

A second lesson from the experience of the 2004–05 vaccine shortage that

is relevant to future vaccine shortages in either an annual influenza season 

or a pandemic is the importance of streamlined mechanisms to make 

vaccine available in an expedited manner. For example, HHS began efforts 

to purchase foreign vaccine that was licensed for use in other countries 

but not the United States shortly after learning in October 2004 that Chiron

would not supply any vaccine. The purchase, however, took several

months to complete, and so vaccine was not available to meet the fall 2004 

demand; by the end of the season, this vaccine had not been used. In 

addition, recipients of this foreign vaccine could have been required to 

sign a consent form and follow up with a health care worker after 

vaccination—steps that, according to health officials we interviewed in 

several states, would be too cumbersome to administer. 

Some states’ experience during the 2004–05 vaccine shortage also 

highlighted the importance of mechanisms to transfer available vaccine 

quickly and easily from one state to another; the lack of mechanisms to do

so delayed redistribution to some states. During the 2004–05 shortage, 

some state health officials reported problems with their ability to purchase 

vaccine, both in paying for vaccine and in administering the transfer 

process. Minnesota, for example, tried to sell its available vaccine to other 

states seeking additional vaccine for their priority populations. According 

to federal and state health officials, however, certain states lacked the 

funding or flexibility under state law to purchase the vaccine when 

Minnesota offered it. As we have previously testified, establishing the 

funding sources, authority, or processes for quick public-sector purchases 

may be needed as part of pandemic preparedness.15

Recognizing the need for mechanisms to make vaccine available in a 

timely manner in the event of a pandemic, HHS has taken some action to

address the fragility of the current influenza vaccine market. In its budget

request for fiscal year 2006, CDC requested $30 million to enter into 

guaranteed-purchase contracts with vaccine manufacturers to help ensure 

vaccine supply. According to the agency, maintaining an abundant supply 

Streamlined 

Mechanisms for

Expediting Vaccine 

Availability Are Key to 

Effective Response 

 15GAO-05-863T. 

Page 8 GAO-06-221T
of annual influenza vaccine is critically important for improving the 

nation’s preparedness for an influenza pandemic. HHS is also taking steps

toward developing a supply of vaccine to protect against avian influenza 

strains that could be involved in a pandemic.16

Experience during the 2004–05 shortage also illustrated the critical role 

communication plays when demand for vaccine exceeds supply and 

information about future vaccine availability is uncertain, as could happen 

in a future annual influenza season or a pandemic. During the 2004–05 

shortage, CDC communicated regularly through a variety of media as the 

situation evolved. State and local officials, however, identified several 

communication lessons for future seasons or if an influenza pandemic 

occurred: 

Effective Response 

Requires Clear and 

Consistent 

Communication

• Consistency among federal, state, and local communications is critical for 

averting confusion. State health officials reported several cases where

inconsistent messages created confusion. Health officials in California, for

example, reported that local radio stations in the state were running two 

public service announcements simultaneously—one from CDC advising 

those aged 65 years and older to be vaccinated, and one from the state 

advising those aged 50 years and older to be vaccinated. 

• Disseminating clear, updated information is especially important when 

responding to changing circumstances. Beginning in October 2004, CDC 

asked individuals who were not in a high-risk group or another priority

group to forgo or defer vaccination; this message, however, did not 

include instructions to check back with their providers later in the season,

when more vaccine had become available. According to CDC, an 

estimated 17.5 million individuals specifically deferred vaccination to save

 16In addition, HHS has also taken steps to stockpile antiviral drugs, which could be

beneficial in the event of a pandemic, before a vaccine specific for the responsible virus

strain is available or during a period of limited vaccine supply. By December 2004, HHS had 

purchased and stockpiled enough of two antiviral medications (rimantadine and

oseltamivir) to treat more than 7 million people, and the department recently announced

intentions to buy enough antiviral drugs to treat 20 million people. Like vaccine, however,

antiviral drugs take several months to produce from raw materials, and HHS’s National 

Vaccine Program Office has reported that in a pandemic, the manufacturing capacity and

supply of antiviral drugs are likely to be less than global demand. 

Page 9 GAO-06-221T
vaccine for those in priority groups;17 local health officials said that many

did not return when vaccine became available. 

• Using diverse media helps reach diverse audiences. During the 2004–05 

influenza season, public health officials emphasized the value of a variety 

of communication methods—such as telephone hotlines, Web sites, and 

bilingual radio advertisements—to reach as many individuals as possible 

and to increase the effectiveness of local efforts to raise vaccination rates. 

In Seattle–King County, Washington, for example, health department

officials reported that a telephone hotline was important because some

seniors did not have Internet access. Public health officials in Miami-Dade

County, Florida, said that bilingual radio advertisements promoting 

influenza vaccine for those in priority groups helped increase the 

effectiveness of local efforts to raise vaccination rates.

• Education can alert providers and the public to prevention alternatives. In 

the 2004–05 shortage, some of the nasal spray vaccine for healthy 

individuals went unused, in part because of fears that the vaccine was too 

new and untested or that the live virus in the nasal spray could be 

transmitted to others.

18 Further, public health officials we interviewed said

that education about all available forms of prevention, including the use of

antiviral medications and good hygiene practices, can help reduce the 

spread of influenza. 

Experience during the 2004–05 influenza vaccine shortage highlights the 

need to prepare the nation for handling future shortages in either an

annual influenza season or an influenza pandemic. In particular, that

season’s shortage emphasized the vital need for early planning, 

mechanisms to make vaccine available, and effective communication to 

ensure available vaccine is targeted to those who need it most. As our 

work over the past 5 years has noted, it is important for federal, state, and

local governments to develop and communicate plans regarding critical 

issues—such as how vaccine will be purchased and distributed, which 

Concluding

Observations 

 17See Centers for Disease Control and Prevention, “Estimated Influenza Vaccination

Coverage among Adults and Children—United States, September 1, 2004–January 31, 2005,”

Morbidity and Mortality Weekly Report, vol. 54, no. 12 (2005), 304–307. 

18The nasal spray vaccine was recommended for individuals aged 5–49 years who were not

pregnant, including some individuals, such as health care workers in this age group and 

household contacts of children younger than 6 months, in the priority groups defined by

CDC. 

Page 10 GAO-06-221T
population groups are likely to have priority for vaccination, and what

communication strategies are most effective—before we face another 

shortage of annual influenza vaccine or, worse, an influenza pandemic. 

For further information about this statement, please contact Marcia

Crosse at (202) 512-7119 or crossem@gao.gov. Kim Yamane, Assistant

Director; George Bogart; Ellen W. Chu; Nicholas Larson; Jennifer Major; 

and Terry Saiki made key contributions to this statement.

GAO Contact and 

Staff 

Acknowledgments 

Page 11 GAO-06-221T
Page 12 GAO-06-221T

Related GAO Products 

Influenza Vaccine: Shortages in 2004–05 Season Underscore Need for

Better Preparation. GAO-05-984. Washington, D.C.: September 30, 2005. 

Influenza Pandemic: Challenges in Preparedness and Response. GAO-05-

863T. Washington, D.C.: June 30, 2005. 

Influenza Pandemic: Challenges Remain in Preparedness. GAO-05-760T. 

Washington, D.C.: May 26, 2005. 

Flu Vaccine: Recent Supply Shortages Underscore Ongoing Challenges. 

GAO-05-177T. Washington, D.C.: November 18, 2004. 

Infectious Disease Preparedness: Federal Challenges in Responding to

Influenza Outbreaks. GAO-04-1100T. Washington, D.C.: September 28, 

2004. 

Public Health Preparedness: Response Capacity Improving, but Much 

Remains to Be Accomplished. GAO-04-458T. Washington, D.C.: February

12, 2004. 

Flu Vaccine: Steps Are Needed to Better Prepare for Possible Future 

Shortages. GAO-01-786T. Washington, D.C.: May 30, 2001. 

Flu Vaccine: Supply Problems Heighten Need to Ensure Access for HighRisk People. GAO-01-624. Washington, D.C.: May 15, 2001. 

Influenza Pandemic: Plan Needed for Federal and State Response. GAO01-4. Washington, D.C.: October 27, 2000. 

(290505)
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Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400 

U.S. Government Accountability Office, 441 G Street NW, Room 7125 

Washington, D.C. 20548 

Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800 

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548 

Obtaining Copies of 

GAO Reports and 

Testimony 

Order by Mail or Phone 

To Report Fraud,

Waste, and Abuse in 

Federal Programs 

Congressional 

Relations 

Public Affairs 

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