Shortages of antibiotics, antivirals, and vaccines threaten the public health.

In this issue of Clinical Infectious Diseases, Strausbaugh et al. [1] present the results of 2 surveys of the Emerging Infections Network (EIN) performed in 1999 and 2000 regarding shortages of certain antibiotics. The EIN is a group of nearly 800 infectious disease physicians from all regions of the country, representing individual , group, and academic practices. They are supported by a contract from the Centers for Disease Control and Prevention (CDC), with the purpose of acting as a sentinel for new and emerging infectious disease problems. Members communicate regularly through the In-ternet, and in 1999, many noted problems in the availability of antibiotics in their practices. As a result, a formal survey of the entire EIN membership was conducted in 1999 and again in 2000. Responses rates (∼65%) were excellent, and although the methods of the survey certainly can be challenged, the results testify to a general problem in availability of such classic drugs as penicillin, gen-tamicin, and many others, including meropenem and ticarcillin-clavulanate. In 1999, ∼60% of respondents experienced at least occasional unavailability of penicillin G, and 30%–40% experienced unavailability of meropenem or genta-micin, respectively. There were some regional differences in shortages, and the shortages seemed to diminish in 2000. In general, patient care was not affected seriously , because in most instances alternative drugs were available, but some patients did receive less-than-optimal care. There were concerns that the shortages may have increased pressure for selection of resistant bacteria, because the alternative drugs used to treat patients had broader spectrums than did the intended antibiotics. This problem is unexpected and alarming. The instinctive question is, if we can produce new immunosuppressive drugs and pay for transplants, prosthetic devices, and numerous other new drugs and innovations, why do we have shortages of antibiotics needed to treat ordinary infections? Unfortunately, shortages of antibiotics are not the only problem; recently there also have been shortages of certain vaccines , antiparasitic drugs, and other biological agents that are sometimes essential for the treatment of infectious diseases. Shortages of ganciclovir were noted by the EIN surveys. There are currently shortages of tetanus vaccine in many areas. Shortages of influenza vaccine caused much concern in 2000 and were the cause of a recent investigation and report by the United States General Accounting Office (GAO-01-624, May 2001). The GAO report on the influenza vaccine shortage is instructive , citing 2 main causes of the delay …