Bulgaria does not have enough flu vaccines, and family doctors now have to decide who gets a jab and who is turned away, says Dr Gergana Nikolova, deputy chair of the National Association of General Practitioners. Pharmacies are short of vaccines too.
This report follows our earlier story on the flu vaccine shortage in Bulgaria. We wrote then that makers had delayed deliveries because the virus strain was chosen late, and that pharmacies expected vaccines around the middle of November.
Bulgaria is running a national flu prevention programme for children for the first time. It uses both nasal and injected vaccines. Some of the nasal vaccines have already reached the surgeries that give them. Together, the two types cover only 17% of children in the age group.
Some family doctors have ordered 500 vaccines each for the children on their lists. Dr Nikolova says the number of orders shows how many children are waiting. She gives the jabs but is not in charge of deliveries, she said.
Until now, patients outside the national programmes were sent to pharmacies. Now pharmacies are running short too. It is hardest for children and adults who pay for the vaccine themselves. They have a right to protection, but there are no vaccines, Dr Nikolova says.
She gave the example of a patient who has had a flu jab for 10 years. He has had a heart attack and a stroke and has a pacemaker, so the vaccine matters a lot for him. To the doctor, these are real people, not abstract numbers.
Her patients also include a brother and sister who are waiting for a vaccine. Dr Nikolova says the boy asked that his sister get it, because he is hardier. The doctor is not sure there will be vaccines for two children from a family in Koprivshtitsa, one of whom is outside the programme. The parents work hard and pay social security contributions, she said.
Some Bulgarians are looking for vaccines in Greece because of the shortage at home. The Greek health ministry said the campaign there began on 1 October, and pharmacies are already vaccinating people who ask. Greece has ordered more than 3.5 million doses, which are arriving in stages. About a third are already in pharmacies, and about 200,000 nasal doses are set aside for children.
Doctors warn that the cold chain may break during transport, meaning the vaccine is not kept at the low temperature it needs. With a vaccine bought elsewhere, nobody knows how it was carried, Dr Nikolova said. It must travel in a special cool bag with cooling packs, not in a pocket while a person walks around town.
As an example, the doctor cited a 4-hour car journey at 23 degrees with the heating on. In her view, giving the jab after such a trip is pointless, because a broken temperature chain can ruin how well the vaccine works.