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BIOSECURITY AND BIOTERRORISM: BIODEFENSE STRATEGY, PRACTICE, AND SCIENCE Volume 3, Number 3, 2005 © Mary Ann Liebert, Inc. Influenza Vaccine Scarcity 2004–05: Implications for Biosecurity and Public Health Preparedness MONICA SCHOCH-SPANA, JOSEPH FITZGERALD, BRADLEY R. KRAMER, and THE UPMC INFLUENZA TASK FORCE In the event of a bioterrorist event or a pandemic flu outbreak, it might be necessary to ration vac- cine or other treatments. In this article, researchers examine how medical and public health decision makers negotiated the unanticipated 2004–05 influenza vaccine shortage, using the regional hospital system headquartered in Pittsburgh, Pennsylvania, as the focal study site. This account of that case study describes the circumstances that contributed to the national and local vaccine shortage; the improvisation by health policymakers, hospital administrators, physicians, and nurses to prevent in- fluenza cases despite the shortfall; and some of the legal, fiscal, logistical, social, and political pres- sures that local health professionals faced in deciding who should receive the limited supply of in- fluenza vaccine. This instance of an acute vaccine shortage provided an opportunity to examine the practical and ethical dilemmas of managing medical resources during a public health emergency. CARCITY OF LIFE-SAVING RESOURCES is one of the most trators, physicians, and nurses to prevent influenza cases Scomplex challenges that decision makers may face despite the shortfall; and some of the legal, fiscal, logisti- when managing the impact of a biological attack, in cal, social, and political pressures that local health pro- terms of medical outcomes, social stability, and confi- fessionals faced in deciding who should receive the lim- dence in government.1–5 Rationing also qualifies as one ited su