Gearing up for the holidays can often mean a quick trip to the travel clinic for a set of shots tailored toward your destination.
But travellers this year might not be fully protected against all diseases, due to ongoing shortages of several common travel vaccines.
Many vaccines for yellow fever, rabies and hepatitis A and B are in short supply, according to the website drugshortagescanada.ca, where drug sellers are required to report when they cannot meet the demand for their product.
Dr. Frank Doane, a travel doctor in Halifax, reported that while he just got a shipment of hepatitis A vaccine last week, these shortages aren’t unusual.
“Almost every day for the last five years, there’s been one of the vaccines that’s been short,” he said. “About four months ago, it was four of the vaccines that were short.”
“There was a period literally where I might as well have closed the shop because I didn’t have enough vaccine to do much business.”
In Winnipeg, a spokesperson for the Winnipeg Regional Health Authority said that their travel clinic is aware of the shortages but believes that it currently has enough vaccine in stock to meet client needs.
“But this can always change as the situation regarding supply is always changing,” wrote spokesperson Paul Turenne in a statement.
“When manufacturers have vaccine shortages – which does happen periodically – we may not be able to get the volume of supply we receive historically, but we do still receive some supply.”
“When such shortages occur, our medical director is consulted and directives for who receives the vaccine are developed based on risk stratification.” Right now, people travelling to places that require yellow fever vaccination are getting priority for all their vaccinations, he said.
Vancouver Coastal Health reported that while they are aware of the shortages for certain vaccines, their travel clinic has not had to turn anyone away.
Drug companies Sanofi Pasteur and GlaxoSmithKline, which make a number of the vaccines currently in short supply, both said in emailed statements that they are diligently working on increasing their availability.
GlaxoSmithKline blames the shortage of its various vaccines on factors like increased demand, delays in supply deliveries and investigations at the vaccination manufacturing sites.
Resupply of its Twinrix combined hepatitis A and B vaccine is currently ongoing, it said, and it expects some of its rabies and hepatitis A vaccines to be resupplied over the next few weeks.
“Shortages can happen for a variety of reasons. This includes unexpected demand, supply chain disruptions (e.g. ingredient sourcing challenges) or production issues. As always, patient safety is our first priority,” said GlaxoSmithKline.
“Vaccine manufacturing is a long and complex process. In particular, some travel vaccines can take up to 36 months to produce, package, and deliver to those who need them,” wrote Maggie Wang Maric, head of communications for Sanofi Pasteur Canada.
Merck Canada, which also makes some vaccines for which there is a shortage, did not return a request for comment.
Travel plans
“Health Canada and the Public Health Agency of Canada were made aware that there is currently a shortage of the yellow fever vaccine in Canada,” wrote Health Canada in a statement. “It is important for travellers to contact a designated Yellow Fever Vaccination Centre well in advance of their trip to ensure that the vaccine is available.”
Yellow fever – a mosquito-borne illness – is potentially deadly, and many countries require proof of vaccination in order to enter.
If you’re unable to get a vaccine, you have a decision to make, said Doane.
“You have to cancel the trip or travel at risk.”
Because yellow fever is carried by mosquitos, you can practice mosquito avoidance, like wearing lots of clothing, using insect repellant, staying in low-risk areas and avoiding going out at dusk and dawn when mosquitos are most active, he said. However, it is a very serious disease, so that needs to be taken into account.
Hepatitis A is transmitted through food, water and between people. “The nice thing about that is it doesn’t kill many people,” he said. “It can make you sick, most people recover and they don’t tend to have permanent liver damage.”
Doane said that when you’re not protected by a vaccine, the key to hepatitis A prevention is to, “Watch what you put in your mouth.”
“Take fresh food and cook it fresh and eat it fresh, you’ll probably do OK,” he said. It’s also a good idea to avoid drinking the local water and eating raw vegetables or salads that may have been washed in it.
Hepatitis B, a more serious illness that can cause permanent liver damage, is easier to avoid.
“If you’re a young 18-year-old going to Cancun for sex and drugs, you’re in trouble,” said Doane.
But most travellers should be fine, he said. The main things to avoid are intravenous drugs, unprotected sex and blood transfusions — all activities he says are associated with a higher risk of getting the disease.
Even though you can often take other actions to prevent illness during travel, Doane believes that something should be done to address what he describes as a “very regular” shortage of travel vaccines.
“These are necessary vaccines that save lives. Why are heads not rolling?”
If you are planning a vacation, you can go to the Government of Canada’s website to see which vaccines are recommended for your destination.
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