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Nonsmoking New York?


Standing outside the cafe he owns in Astoria, Kosta Litzeris smokes a Salem cigarette as he greets a stream of regular customers with kisses on the cheek and pleasantries in Greek. Some customers, once they move through the door and settle in for ouzo or espresso, light up their own cigarettes, despite city and state laws forbidding it.

Litzeris has accepted that $1,000 fines are a regular cost of doing his brand of business. According to the city's Department of Health and Mental Hyigiene, Litzeris' establishment, Café Kolonaki, is one of the die-hard resisters of New York's two-year old smoking ban. It recently included the café among nine restaurants and bars that "willfully and continuously violate" the smoking ban.

But Litzeris says pressure from the city has made it clear that the time has come to change his ways.

"We're trying to push [the smokers] outside now, because the weather is good," he said. "We're trying to take it on slowly."

In the past few years, New York has become a far less friendly place for smokers. Cigarettes cost about $3 more in New York City than the national average, thanks to heavy state and local taxes, and there are far fewer places to light up thanks to state and local bans on smoking in workplaces. The city and state have also been focusing increasingly on programs to help smokers quit. As a result, say city and state officials, fewer New Yorkers smoke, and New York has served as a model for other places wanting to take similar antismoking actions. Antismoking advocates see this as part of a sweeping nationwide, and even international, trend that goes beyond government initiatives.

"A major social change has been underway for a long time," said Russell Sciandra of the Center for a Tobacco Free New York. "The enactment of [the smoking ban] was a landmark in that social change, but it was happening anyway without legislative action."

But recent studies shows that New York is failing to collect its taxes, even as the smoking ban seems to have taken a strong hold. Increasingly restrictive legislation is also being considered: some state lawmakers want to raise the smoking age to 19, while starting last week, 18 year olds in Suffolk county are no longer able to buy cigarettes legally.

As they work on those policies already in place, even some antismoking advocates have begun to wonder if New York's anti-smoking fervor is headed in the wrong direction.

TAXES AND BANS: NEW YORK'S ANTISMOKING LEGISLATION

In 2002, New York City imposed a tax of $1.42 on cigarettes -- adding to a similar state tax -- and banned smoking in all workplaces, most notably bars, nightclubs and restaurants. Suddenly, New York City had the most expensive cigarettes in the country at about $7 a pack, and the country's strongest ban on smoking in public places. Statewide, cigarettes cost about $6 a pack, as opposed to about $4 for the nation as a whole.

The effect, officials say, has been a drop in the number of smokers. Mayor Bloomberg recently claimed that there are 130,000 fewer smokers in the city than there were in 2002, while an independent assessment (in pdf format) of New York State's antismoking efforts show that cigarette sales in the state are dropping faster than they are in the country as a whole.

Can New York Collect The Tobacco Tax?

The tobacco tax was described as a way to discourage people from smoking, rather than as a way to raise money. Bloomberg has said that he would prefer that the city tax be so high that it adds no revenue to the city's coffers. Both city and state taxes are generally given a lot of credit in driving down the number of smokers. Heavy taxation of tobacco, say antismoking advocates, is particularly effective in discouraging young people from smoking because they are less affluent and less addicted than adult smokers.

But those who have analyzed the numbers measuring the tax's success say that may be deceptive, because the high tax has simply sent many smokers to the black market.

In a recent analysis Andrew Hyland, who studies health policy at Roswell Park Cancer Institute, claims that smoking rates have not dropped as quickly as one would expect considering the price increase. In addition, his analysis shows, New York State is losing between $470 million and $635 million annually in tobacco taxes.

"I think that one of the primary reasons for that is that smokers have switched their purchasing patterns," said Hyland.

Plenty of places remain where New Yorkers can buy tax-free cigarettes. According to the Bureau of Alcohol, Tobacco and Firearms, 45 percent of New York State residents "sometimes" or "always" bought tax free cigarettes in 2003 and 2004, either by traveling to American Indian reservations or other states, or by buying cigarettes over the phone or online.

Thomas Frieden, the city's health commissioner, said in a recent interview that for the city's antismoking policies to truly be effective, state and federal enforcement efforts are key.

The state has taken several steps. Governor George Pataki recently signed into law a bill that would stop non-Indians from buying tax-free cigarettes on American Indian reservations. New York State has been failing to pursue this uncollected revenue, something which Hyland says costs it up to $300 million annually.

The state attorney general's office and the federal Bureau of Alcohol, Tobacco and Firearms also came to an agreement with credit card companies in March to stem Internet sales. Such sales have long been illegal in New York because it is impossible to verify a consumer's age online with any degree of reliability. Because credit card companies generally have policies that forbid cardholders from using their cards for illegal purposes, the companies agreed to stop allowing their cards to be used for online cigarette purchases at all.

Advocates are waiting to see how well such measures are implemented before counting them as a victory. The state attorney general's office says that it has anecdotal evidence that online tobacco retailers -- who it sees as criminals -- have been harmed by its agreement with the credit card companies.

But other illicit online industries, such as gambling, have found ways around similar restrictions in the past. Both advocates and officials are convinced that online tobacco retailers will find such a way to adapt to this measure as well.

Have Fears About The Smoking Ban Come True?

Banning smoking in bars and restaurants has arguably been the most controversial thing that Bloomberg has done in his four years as mayor. Signs can still be seen near outdoor ashtrays outside of Manhattan bars showing the mayor with his pants down, urging him to "Butt Out," and it is not difficult to get those who object to the idea of a ban to explain their reasoning at great length. But despite some persistently loud opposition, implementation of the smoking ban has presented less serious problems than implementation of the tax.

The ban was originally envisioned as a workers' safety issue. By having to inhale second hand smoke, proponents of the law argued, bartenders, waitresses and others were being forced to work in unreasonably dangerous conditions. Opponents said they objected in principle to such "government nannyism", that bargoers would wreak noisy havoc on city streets once forced out of doors, or that smokers would feel so shunned by the law that they would simply refuse to patronize bars and restaurants.

City and state officials say that the past two years have vindicated those who supported the law. A year after the ban went into effect, the city said that the level of cotinine, a byproduct of nicotine, had dropped 85 percent in nonsmoking workers at bars and restaurants, a sign that it took to indicate success in its primary goal.

Further, both city and state studies show there has been no nightlife crash. The state's Department of Taxation and Finance published a report last month that analyzed tax revenues, showing that business suffered for about six months after the ban, but then picked back up. Bars did the worst -- their business was six percent lower in the first three months after the ban compared to the same period one year earlier. The next year, however, business had crept back up five percent, still slightly lower than it was before the ban in 2002, but on the upswing.

Neither the state nor those who remain opposed to the ban believe such broad statistics tell the whole story, because they do not take into account factors like the improving economy or changes in state taxes.

Some opponents of the ban, who admit that the restaurant and bar industry as a whole may not have suffered, still argue that certain businesses have been hurt badly nonetheless. One Web site has a list of bars and restaurants that claim to have suffered from the ban, including a dozen establishments that have supposedly gone out of business at least in part because of it. Litzeris claims that Café Kolonaki didn't allow smoking for the first month of the ban, but suffered from such a dramatic drop in business that he had to change tact. He is gloomy about being forced to comply with the law he has flouted for the last two years.

"It will shut us down," he said.

Charles Hunt, executive director of the New York City chapter of the New York State Restaurant Owners Association, questions whether businesses that go out of business can reasonably blame the ban, but he does believe that a certain type of business has been harmed.

"The neighborhood tavern where they open the doors at eight in the morning and sixteen retired guys sit around smoking and played cards - or did. These are the places that got hurt," he said.

Hunt's group opposed the city ban, but he is not the ban's only political opponent who said that he personally enjoys the lack of smoke when he goes out.

Meanwhile, antismoking advocates -- Mayor Bloomberg included -- point out that New York's positive experience is spreading momentum for bans in other places. Since New York City and New York State passed bans on smoking, the pace at which other areas passed bans increased dramatically. In 2004, 69 cities implemented smoking bans, compared to 34 in 2002, the year before New York's bans took effect. Ten states and several countries including Italy and Ireland have decided to implement bans of some sort, and over 100 million Americans now live in places with smoking bans (in pdf format), according to the American Nonsmokers' Rights Foundation.

While it is difficult to credit New York for directly inspiring any of these laws, the health department says it has been fielding a stream of inquiries from other jurisdictions interested in implementing their own bans. Even detractors of the ban agree that its effect has been profound.

"I knew that if New York City went, the rest of the country would go," said Audrey Silk, the founder of New York City Citizens Lobbying Against Smoker Harassment, a group opposing smoking bans and increased tobacco taxes. "Not to be snobby New Yorkers, but we're trend setters: 'If New York can do it, we can do it.' And we saw that happen immediately."

LOOKING AHEAD IN A CHANGED ATMOSPHERE

Advocates still find plenty of shortcomings in New York's tobacco control efforts. The billion dollars coming in annually from the tobacco tax and the hundreds of millions that the state receives from a nationwide legal settlement against tobacco companies do not translate into more money for such efforts. The state currently spends $40 million a year on tobacco control, less than half of the Centers for Disease Control's recommended level. The tobacco companies spend 200 times that amount promoting its products in New York State annually, according to the American Lung Association of the City of New York.

But Blair Horner of New York Public Interest Group believes that the tobacco tax and the smoking ban have caused a significant political shift, weakening the tobacco companies' traditionally powerful influence on New York State policymakers.

According to Horner, this trend actually started in 1999 when a scandal broke out over Philip Morris (now Altria) illegally giving gifts to state legislator. (Horner detailed the scandal in an online book). The scandal led legislators to prove their good intentions towards tobacco control measures according to Horner. "Once lawmakers got used to passing pro-health measures -- or anti-tobacco measures depending on how you look at it -- it seemed to create its own momentum," he said.

There is evidence of the anti-tobacco momentum in New York City and State. The city is in its third year of an expanding program to give away free nicotine patches, with Pfizer, a company that manufactures the patches, donating millions of dollars worth of its product to the city. New York State's average annual tobacco control budget this decade is ten times higher than it was in the 1990s. It is the only state in the country to have legislation mandating that efforts be taken to manufacture cigarettes that are less likely to start fires.

Also, within the last month there has been movement in Albany to raise the smoking age to 19, a measures that Long Island's Suffolk County has already adopted on the local level.

The prospect of raising the smoking age has left some antismoking advocates feeling that their regular allies are overreaching. Smoking is, after all, legal, and 18 year olds are adults, said Horner, adding that this particular measure has not been effective in other states that have implemented it. Other antismoking advocates have said that even if they do agree with raising the smoking age, it should take a secondary role to other efforts like antismoking advertisments; health commissioner Frieden says he has no opinion on the subject.

For pro-smoking activist Silk, the movement to raise the smoking age is just another sign that legal prudishness is spreading. Junk food and other unhealthy behaviors, she says, may be next.

So while the atmosphere is distinctly hostile to her views at the current moment, Silk holds out hope that the antismoking trend will not always be in vogue.

"Alcohol prohibition lasted 13 years and there was a constitutional amendment, but it was overturned eventually," she said. "It's fashionable now to beat up on smokers, but liberty could be fashionable again ten or fifteen years from now."

The New York Libertarian Party has nominated Silk to run for mayor, and she says that her candidacy will be a way to voice the pro-smoking perspective. She does admit that her campaign is going slowly, though. The reason, says Silk, is that she refuses to go to Libertarian party meetings because they make her go outside to smoke.

FOR MORE INFORMATION

Organizations

New York City Department of Health
Tobacco Control Page
Center for a Tobacco Free New York
New York City Citizens Lobbying Against Smoker Harassment
Americans for Nonsmokers' Rights
American Lung Association of the City of New York

Gotham Gazette Articles

Smoked Out (July 2001)
Smoking in New York (July 2002)
New York City's Blue Laws (May 2003)

Reports Etc. (in .pdf format)

First Annual Independent Evaluation of New York State's Tobacco Control Program (by the Tobacco Use Research Program at Research Triangle Institute)
The State of a Smoke Free New York, A One Year Review (by the City of New York)
List of Places With Indoor Smoking Bans (by the American Nonsmokers' Rights Foundation)
Blowing Away the Smokescreen: The Case Against Big Tobacco (by the New York Public Interest Research Group)

 

 

AIDS In New York City


Representation of the
Human Immunodeficiency Virus

Related in Community Gazettes:
• AIDS 50+
• Fighting AIDS with Needle Exchanges

On a trip to visit family in South Carolina, Niko Flowers, who lives in Kew Gardens, Queens, asked after a cousin. The cousin recently died of AIDS, her family told her. Flowers was surprised: Nobody had even mentioned that her cousin was infected.

But she understood. "When I got diagnosed," Flowers said, "I didn't tell anybody for four years."

Flowers has been living with AIDS now for 15 years, after contracting it from a boyfriend when she was in college. She is no longer silent about it. She works for Love Heals, which sends people with AIDS to speak out about the disease.

The teenagers to whom she speaks, though, do not always like to talk about it. Neither do most New Yorkers, who may see it as a distant disease, a manageable disease, a gay disease, or an African disease -- as nothing connected to their own lives, or even to their own city.

Last month, the city began to speak about AIDS once again with a sense of urgency, when City Health Commissioner Thomas Frieden announced that a New York man had been infected with what appeared to be a new, drug resistant strain of AIDS.

Even though the scientific merits of the case were immediately brought under question, Frieden's announcement inspired more media attention around AIDS than there had been in years.

The frenzy soon faded; the silence resumed. Many advocates, though, say that the recent discussion was never about the real threats from AIDS. The issues, they say, persist.

HIGH RATE OF INFECTIONS

New York has long been known as the center of the domestic AIDS crisis. The AIDS rate in New York State remains at about double the national rate for men and triple the national rate for women. There are 90,298 city residents known to be living with AIDS, and up to 45,000 more who don’t know that they’re infected. In the quarter century since the AIDS epidemnic began, the city has suffered 16 percent of the national death toll, with over 85,000 AIDS casualties to date. (summary of most recent NYC AIDS statistics in pdf format).

The reasons cited for New York's high AIDS rates include the city's high levels of drug use, a permissive sexual atmosphere and widespread poverty. The combination of these factors is what makes New York’s epidemic distinct.

While the number of new AIDS cases in New York has continued to decline since 1995 -- there were 5,552 cases in 2002 and 4,205 in 2003 -- experts see worrisome signs. Nationwide, the number of new HIV diagnoses has been increasing slightly since 2001, in a reversal of a previous trend, according to the Centers for Disease Control and Prevention. Some see this as evidence of the growing ineffectiveness of safe sex campaigns throughout the nation. And there is plenty of evidence that such campaigns are increasingly ineffective in New York as well. In a 2003 survey (In PDF format) by the Department of Health less than half of gay men said they used a condom the last time they had sex (in pdf format). Condom use among straight men and women was even lower. Experts also point to a rising number of syphilis to show that more New Yorkers are having unsafe sex. It is just a matter of time, some worry, until the number of AIDS cases in New York will start to follow the national upswing.

DIFFERENT POPULATIONS AT RISK

Most new HIV infections in New York City are still contracted by men through sex with other men, but the proportion of new infections being passed through heterosexual sex is rising sharply. In the first quarter of 2004, 22 percent of new diagnoses were among heterosexuals, up from 16 percent a year before. The disease is also becoming an increasing problem among women, according to a recent report by the Department of Health (in pdf format).

Like other issues where economic wellbeing plays a role, minorities suffer disproportionately. Blacks are three times as likely to be HIV positive than whites; Hispanics are twice as likely. People of color are also much less likely to know their status; six of ten black New Yorkers diagnosed with HIV find out their status on the same day they are diagnosed with full-blown AIDS. Once infected, people of color die at higher rates than white New Yorkers do, mainly because they have poorer access to medical care.

NEW CHALLENGES RELATED TO LOWER DEATH RATES

Overall, death rates have been declining drastically since the advent of better drug treatments in the mid-1990s. This success has come with new challenges.

Aside from making it harder to keep AIDS in the public consciousness, lower death rates have meant more people living with AIDS. Some 67 percent of people with AIDS are now over the age of 40; 28 percent over the age of 50. As they age, new problems surface: Most AIDS drugs, for example, have only been tested on younger people; the potential side effects or effectiveness of certain treatments for older people are unknown. (See the article on AIDS Over 50 in the Community Gazettes for Greenwich Village.)

New York’s AIDS housing system is facing an impending crisis, according to a recent report commissioned by the city (in pdf format). As people live longer, healthier lives, they are also more likely to be able to return to work, leaving advocates and the city to design back-to-work programs tailored to the needs of people with AIDS.

NEW YORK CITY PREVENTION EFFORTS

If AIDS has been particularly brutal in New York, it has forced New Yorkers to become especially effective in fighting back.

New York’s efforts on AIDS are largely carried out by a network of community organizations, which city officials cite as a vital part of the response to the disease.

These organizations spend significant energy advocating various approaches that the city government should focus on. The debate, say activists and city officials, helps both sides by disciplining them. Activists praise the Bloomberg administration for engaging in this debate in a way former Mayor Rudolph Giuliani was never willing to.

Needle Exchange

Mayor Michael Bloomberg’s approach to AIDS centers on encouraging people to know their HIV status by expanding the places where people can get tested and making the testing process quicker and easier.

He also has focused on syringe exchanges. Advocates see this as the Bloomberg administration’s most tangible success on AIDS. Last year, the city opened the first needle exchange in Queens, the last borough without one, and is planning several more. ( See Fighting AIDS With Needle Exchanges" in the Community Gazette for Long Island City)

In the first quarter of 2004 the number of people with injection drug histories who were newly diagnosed dropped to 88 from 156 the year before.

Testing And Information-Gathering In The Face Of Stigma

When New York City Health Commissioner Thomas Frieden announced that a man had become infected with what seemed to be a new strain of AIDS that progressed rapidly and resisted medicine, the scientific community was not immediately convinced that the new case merited all the attention it was receiving. The long-term clinical significance has yet to be determined. Meanwhile, the health department has been accused of being alarmist.

The health department said the possibly new strain of AIDS has made it all the more important that people be tested for HIV, something the agency long had been promoting in any case. While some activists publicly contemplated radical measures, Frieden said he would like to change at least one law to allow better information-gathering on the disease.

The commissioner said that he has no intention of rolling back confidentiality protections, but some say that for some time he has been hinting at doing just that. His past record of encouraging forced hospitalization for tuberculosis patients has led some to question his judgment on the balance between civil rights and aggressive medicine.

Critics say that civil liberties require particular care with regards to AIDS because stigma about the disease still poses an obstacle to prevention efforts. "Frieden comes from a tuberculosis approach,” said Julie Davids of Community HIV/AIDS Mobilization Project. “I don't think his means are going to get the ends that we need.”

Isacc Weisfuse, the department’s deputy commissioner for disease control, says that the department is looking at the success in reducing tuberculosis rates for inspiration in working with AIDS, but he acknowledges that not all techniques will transfer. He bristles at the suggestion that privacy could be compromised.

AIDS And The Public Schools

The school system is seriously lacking in health teachers, and 63 percent of school districts don’t meet state requirements for the number of teachers trained to teach about HIV/AIDS, according to a 2003 report by State Assemblyman Scott Stringer. Many schools, he says, simply avoid talking about AIDS altogether; some bring in outside groups like Love Heals instead of having their own teachers take the responsibility of informing the students.

When public schools do teach about AIDS and other sex education topics, the guide they use describes AIDS as a disease that primarily affects gay men, talks little about how it has affected communities of color, and informs students on the use of birth control methods that were discontinued years ago. Neither the overall health curriculum nor the HIV/AIDS curriculum has been updated since 1991.

After sustained pressure, the Department of Education says that it has drafted replacement curriculums for health and HIV/AIDS. Activists have criticized the HIV/AIDS curriculum for avoiding frank discussions of drug use; the health curriculum, they complain, doesn’t cover sexual orientation. After input from parents and advocates, the health department says the new lessons will be in place by September.

The New York AIDS Coalition is working with the city, but is not convinced their partner is committed. “When it comes to the Department of Education, they have other priorities,” said Kazanas. “If it’s not about reading and writing scores, it’s really not on their radar.”

NEW YORK MONEY: DEFYING THE FEDS

When Bloomberg decided to focus on needle exchanges he was defying the official wishes of the federal government, which has banned the use of federal funds for syringe exchanges since the late 1980s. New York’s ability to run its own program illustrates one of the city’s major strengths: it has its own money.

New York City and New York State are recognized as places that put more taxpayer money towards HIV and AIDS programs than elsewhere. The flexibility afforded by these funds has long allowed New York to innovate with HIV/AIDS policies.

In this year’s proposed budget, Bloomberg has proposed a permanent allocation of $5 million to the Department of Health’s budget for prevention efforts in communities of color. The money itself is not new; the City Council has been putting it aside for several years. But making it permanent will make it easier to plan ongoing programs.

FEDERAL MONEY: CUTS AND STRINGS

As elsewhere in the country, the majority of funding for AIDS prevention and services in New York comes from the federal government.

Services

Funding for those who need expensive treatment is declining on the federal level. President George W. Bush has proposed sharp cuts for Medicaid, and the Ryan White CARE Act, two of the major ways in which people with AIDS get medical treatment. There is also less money for federally funded AIDS housing.

Research

New York is at the center of efforts to develop an AIDS vaccine. Researchers at the Aaron Diamond Research Center began enrolling New Yorkers in the first critical trial of a new AIDS vaccine, called ADMVA. The federal government funds virus research at Columbia University and the New York Blood Center. And the blood center is the Manhattan trial site for a vaccine effort by Merck Pharmaceuticals. Likening such efforts to the long quest for a polio vaccine, experts caution that similar efforts to stops AIDS will require money and commitment.

But after a large increase in the 1990s, the federal AIDS research budget (which is now about three billion dollars a year) has leveled off, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which supports and conducts AIDS research.

Prevention

For those working on prevention, not only is funding being cut, but the type of work that is being funded is also being redefined.

In 2003, the Centers for Disease Control, frustrated with the nation’s lack of success in HIV prevention, developed a new strategy that put an increasing focus on preventing new infections by identifying people who are already infected and working with them to cut down on interactions through which they might infect others. It insisted that those organizations that receive funding for prevention do the same.

The agency describes its decision as a way to bring discipline to AIDS prevention. But private AIDS organizations, many relying solely on federal grants to stay in existence, say they are seriously burdened by the new approach.

"Because certain people pull the purse strings, one feels that one doesn't have a choice but to go along with the way they do things,” said Tokes Osubu, executive director of Harlem-based Gay Men of African Descent, which has seen its budget cut by about 80 percent.

Activists regularly complain that groups working primarily with gay men have the most trouble getting funding. Because the current administration has been encouraging abstinence-only sex education, those teaching about safe sex often feel left out.

Aside from hampering the actions of specific organizations, many feel that the federal government’s controlling approach has taken away one of the best ways to keep AIDS prevention effective: allow those working among particular communities to adjust to the specific needs of each community.

By adopting a nationwide standard, says Kazanas, the federal government is ignoring the complexity of an epidemic that is different in every place it is present.

“We have a better grasp and a better handle on the needs of our particular epidemic than somebody sitting in Washington.”

FOR MORE INFORMATION

Organizations
New York City Department of Health and Mental Hygiene
New York State Department of Health
Housing Works
New York AIDS Coalition
Gay Men’s Health Crisis
Harm Reduction Coalition

Resources
Coalition Searchable Database of AIDS information
Directory of New York Department of Health Studies on AIDS
Henry J. Kaiser Foundation Introduction to HIV/AIDS in New York State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Flu -- An Ironic Season


A few short months ago, health officials were worried about this year's flu season because of a sudden shortage of the vaccine. Only two companies manufacture flu vaccines for the entire United States of America, and one of them was unable to deliver the product. New York City started the season in October with 600,000 fewer vaccine shots than officials said they needed and, along with the rest of the county, implemented a policy allowing only people at "high risk" for the disease to receive shots.

Now, health officials are still worried, but for a different reason. There is an adequate supply in New York City for groups at risk. The problem is now the demand. "We don't want those doses to go to waste," said Dr. Julie Gerberding, director of the federal Centers for Disease Control in an announcement in December recommending the list of "priority groups" for the vaccine be expanded.

Fewer Shots, More Flu

Influenza is more than an inconvenience. It causes an average of 36,000 deaths a year in the United States and sends about 230,000 people to hospitals.

Yet, as of December 22nd, only 17 percent of Americans had received flu vaccines, half as many as last year or the year before, according to a Wall Street Journal Online/Harris Interactive health-care poll. And of at-risk adults who qualify for the shots, 47 percent reported they had not even tried to get one this year.

Not surprisingly, flu cases are reportedly on the rise. New York was the first state to report "widespread influenza activity" according to the Centers for Disease Control.

The New York City Department of Health and Mental Hygiene announced on December 21st that it "had identified 21 outbreaks in health care or other institutional facilities so far this season, nearly twice as many as had been reported by this time last year." The department also reported there are now adequate supplies of flu vaccine in New York City and advised the medical community to "make sure patients at highest risk of serious illness from the flu get vaccinated."

No Longer A Shortage For New Yorkers At High Risk

In New York City, the shortage of vaccine shots was addressed when federal health officials made plans in November to divvy up the national supply of vaccine based on the concentration of high risk groups in different areas. The city has already received 900,000 doses of vaccine from the federal government and anticipates receiving over 275,000 more.

To further alleviate the problem, New York City joined Illinois, New Mexico and Cleveland in a bid to obtain additional doses from European manufacturers. However, the federal government is still deciding whether it will allow the vaccines into the country, and flu season may be over by the time it does.

For now, New York City health officials say there is still not an adequate supply to vaccinate everybody, but there is enough for those considered high-risk:

  • People 65 and older. (The city is now considering lowering the age to 50);
  • Children 6 to 23 months of age;
  • Residents of nursing homes and chronic-care facilities;
  • People age 6 months and older with chronic medical conditions, including heart disease, pulmonary disorders (including asthma), diabetes, kidney disease, hemoglobinopathies, and compromised immune systems (HIV or immunosuppressive therapy);
  • Women who will be pregnant (at any gestational age) during the influenza season;
  • Children and adolescents, age 6 months to 18 years, receiving long-term aspirin therapy;
  • Healthcare workers providing direct patient care;
  • and caregivers of children under 6 months of age.

Flu shots are now available for these groups, but media coverage of the flu epidemic has declined, and health officials seem worried the shots will go unused. "Many New Yorkers were discouraged from seeking a flu shot this season, even as more vaccine became available," New York City Health Commissioner Dr. Thomas R. Frieden said in a statement. Because so many people stayed home rather than receiving their annual flu shot, he said, "there are likely to be more flu-related deaths this year."

Is There A Better Way?

Stephen S. Morse, director of Columbia University's Center for Public Health Preparedness, says this is not necessarily true. It is hard to predict the virus's movement or gauge the efficacy of the health department's vaccination program this early in the flu season. "It's always an issue of supply and demand," he said, "and only time will tell if the hard-working health department predicted the demand correctly." Last year, he added, the companies producing the vaccines anticipated too large a demand and over-produced the shots. "They ended up throwing out 10 million doses nationally."

It is especially hard to make predictions when the two major forecasters each year, public health departments and private drug companies, have different agendas. For the drug companies that produce the vaccines, profits remain an issue -- and flu vaccines are generally not very profitable. For one thing, they are only administered once; other drugs may be taken several times a day for long periods of time.

Additionally, the cost is high for identifying the particular strain of flu set to arise each year and producing a new vaccine to combat it. And in some cases, scientists make incorrect predictions, meaning months of work -- and months of funding -- are wasted. For these reasons, Dr. Morse said, many drug companies opt not to make flu vaccines. If it turns out that this year's demand exceeds supply, however, more companies, such as those operating only in Europe, may want to jump in.

European countries have avoided shortages by relying on more pharmaceutical companies for the vaccines. Health experts overseas have long criticized the U.S. handling of flu vaccines, according to the New York Times. Britain "spread its order for flu vaccines among five suppliers, precisely to avoid the kind of predicament America now faces."

There are also vaccines that have been approved for use in Europe but not in the United States. More approved vaccines could mean less reliance on a single company. This season, Fluarix, a vaccine used in Europe but not here, was authorized on an emergency basis for use in the United States. Reuters reported that health officials agreed to buy up to four million doses of the vaccine from a plant in Germany.

ANTIVIRAL DRUGS

Drug companies might be interested in producing more than just vaccines. Antiviral drugs can be used during vaccine shortages to treat high-risk groups, such as the elderly living in nursing homes, where disease spreads quickly. Antivirals make it impossible for the virus cells to reproduce in the body and can be used to prevent or treat certain types of flu.

According to a recent study at the University of Vermont Medical School published in the New England Journal of Medicine, amantadine, one of these drugs, was 91 percent effective at preventing the flu in a group of 450 volunteers. Dr. Alan Kendal of the federal Centers for Disease Control said that, ''in special cases, such as an epidemic of flu at a nursing home, amantadine may serve as a useful supplement in protecting high-risk people in the period before the vaccine can take effect.''

Though antiviral medications work well, there are several problems with relying on them for treatment. To prevent the flu, they must be taken within two days of getting sick, according to a report from the Centers for Disease Control. Because they are available by prescription only, people must see a doctor at the first sign of the flu to receive them. Though they can shorten the length of infection, for a typical weeklong bout, the difference in recovery time would be only a day or two. Further, the antivirals only work for type A influenza, not the common cold or other forms of the flu.

For the most part, antivirals are used in combination with vaccines to treat people at risk of complications from influenza. According to the statement, they are most often used "to control flu outbreaks in institutions, for example in nursing homes, or in hospital wards, where people at high risk for complications from flu are in close contact with each other."

Due to the vaccine shortage, antiviral drugs have been widely used this year. The American Society of Health-System Pharmacists quoted Health and Human Services Secretary Tommy G. Thompson as saying that this year the country would have enough antiviral drugs to care for about 40 million people. It also reported that "the CDC is concerned about the development of drug resistance if the products are used for treatment as well as prophylaxis."

As health departments increase supplies of vaccine and antivirals, and media attention to the issue declines, Secretary Thompson advised people in high-risk categories to be "patient but also be persistent" in seeking vaccine.

For more information about flu, or where to get a flu shot from the Health Department, call 311 or visit the department's flu page.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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