If the Southern Nevada Health District made H1N1 vaccine available to people 25 to 64 with certain chronic health conditions, a high-risk group for swine flu, the supply could be depleted before many children could be vaccinated.
The pool of people eligible for the vaccine would more than triple at clinics, creating a demand that currently couldn't be met, according to Dr. Lawrence Sands, the district's chief health officer.
On Friday, Sands explained the rationale behind denying the group the medication while keeping a stockpile of at least 6,000 doses of the injectable version of the vaccine on reserve.
That injectable type is required for those in this particular priority group, which the federal Centers of Disease Control and Prevention has recommended be among the first in line for vaccinations.
"We certainly understand the concerns of a group being excluded," Sands said as his staff prepared for today's clinics in Las Vegas and Henderson. "But when you have a limited supply of vaccine and you look at who's getting the disease, it's the younger age groups.
"By vaccinating younger age groups, it protects everyone else," he said.
That's because young people are more likely carriers of the disease. If they're immunized, H1N1 is less likely to spread.
In a shortage situation, according to the CDC, the 25-64 group can be excluded from receiving the vaccine.
Sands noted that about 250,000 people in Southern Nevada comprise the four CDC priority groups now given vaccinations by the district: pregnant women; caregivers or those with children under 6 months old; health care workers and emergency responders; and those between 6 months and 24 years old.
If the Health District also serviced the CDC's fifth priority group -- 25 to 64 with chronic health conditions such as asthma, diabetes and obesity -- the overall pool of vaccine-eligible people would grow by about 650,000, Sands said, a huge number of potential patients that could dry up supply needed for pregnant women and children.
"We have a long way to go to cover (the priority groups) we are dealing with," Sands said.
Through Friday, 78,000 doses of vaccine had been shipped to the Health District and an additional 57,700 to private health care providers in Clark County, district officials said. That includes this week's shipment of 8,400 doses to the district and more than 29,000 to private providers.
The Health District has so far vaccinated only 28,000 people. No information is available on how many people have been vaccinated by private practitioners in the Las Vegas Valley.
Although health districts around the country are facing similar shortages of vaccine, Sands conceded many of them have chosen not to exclude a CDC priority group.
"It's all over the place," he said of how various locales set their protocol. "Every community has different dynamics."
In Washoe County, for instance, public health officials consider it discriminatory to favor any one priority group over another.
Dr. Randall Todd, head of public health preparedness in Washoe County, also disagrees with sitting on vaccine, as Clark County has done.
"We don't have a problem with the supply getting down to zero," he said Thursday. "We want to get it out to the people in all the priority groups as fast as we can."
But Sands said he has held vaccine back so that during major clinics, such as those held today, there won't be shortages.
"We don't want people standing in line for hours and then run out," he said.
Todd acknowledged that did happen in Washoe County during one clinic.
"People were angry," he said.
Sands said he believes Southern Nevada has received its fair share of vaccine, noting the CDC parcels it out by population. He said that past health scares don't bear out an argument for Las Vegas receiving more vaccine because it's a tourist destination.
Just because there's a large number of tourists in town doesn't mean more locals are more susceptible to a disease outbreak, he said.
"Statistics just don't bear that out."
Sands said there are people who have been critical of big businesses, including banks, in New York receiving vaccine for employees, but he pointed out that public health officials have long done such outreach. The same could be done here by large corporations, including casinos, he said, as long as public health guidelines are followed.
"It's really not a bad public health strategy," he said, noting that the goal is to get people vaccinated as quickly and efficiently as possible.
But Las Vegan Loretta Gatti, 60, doesn't appreciate the strategy the Southern Nevada Health District is taking and is concerned the district isn't offering vaccinations to people with medical conditions in her age group.
Gatti suffers from chronic obstructive pulmonary disease and uses an oxygen tank while she sleeps.
"I wake up in the morning and my heart is racing," she said. "Even if I get bronchitis, I end up in the ER. If I get the flu and it goes to my lungs, I'm dead."
Private physicians are allowed to give H1N1 vaccinations to people in Gatti's age bracket with chronic health conditions, but her doctor doesn't have the vaccine. And she said she isn't strong enough to travel to Washoe County.
Though she is frustrated by the district's position, Gatti said she would never want to take vaccine away from a child.
"If it comes down between me and my grandchildren, they come first," she said. "Young people are dying. I never worried about getting sick or dying when I was younger."
Tom Skinner, a CDC spokesman, said Friday that older people should remember that antiviral medications, such as Tamiflu, lessen the severity of flu symptoms.
"It's an option ... to take, to prevent getting the flu and then if they come down with it, it can help treat the illness," he said.
Skinner predicts the vaccine will become more widely available by the end of the month or in early December.
Sands hopes so.
"I want to give the vaccine to as many people as we can," he said.
Review-Journal writer Mike Blasky contributed to this report. Contact reporter Paul Harasim at email@example.com or 702-387-2908.
Healthy people, including women who are not pregnant, who are between the ages of 2 and 49 and live with or care for children younger than 6 months of age
People with underlying medical conditions or over the age of 49 who live with or care for children younger than 6 months of age
Health care and emergency medical services personnel 49 years of age and younger with direct patient contact
Health care and emergency medical services personnel 50 years of age and older, or with underlying medical conditions, who have direct patient contact
All children 6 months up to 2 years of age
Healthy people and women who are not pregnant between the ages of 2 and 24 years
Children between the ages of 2 and 18 years with underlying medical conditions
Two H1N1 immunization clinics will be held between 10 a.m. and 6 p.m. today at Southern Nevada Health District centers in Las Vegas and Henderson. The Las Vegas location is 625 Shadow Lane; the Henderson location is 520 E. Lake Mead Parkway.
The vaccine is free.