Supply, demand, the likely number of needle-phobics and the cost of trashing unused vaccine are among the factors considered when ordering flu shots for a health maintenance organization, said Barbara Kashiwabara, director of pharmacy services of Kaiser Permanente Hawai'i.

As of late last week, Kaiser had gone through 93 percent of its supply of flu vaccine, leaving only about 4,000 shots, she said.

Kaiser previously had said 30 percent of its vaccine supply remained. Not so, a Kaiser spokesman said yesterday.

Last spring, when vaccine orders were placed, Kaiser had planned to use up to 90 percent of its supply by the end of December, Kashiwabara said. They're ahead of schedule.

Although an additional 10,000 doses have been ordered, Kashiwabara said, Kaiser's supplier isn't guaranteeing they're going to get it.

The situation is much different than in previous years, she said.

"Last year," she said, "we had 65,000 doses, and we wasted quite a bit of it."

Because of nationwide shortages last year, the U.S. Centers for Disease Control and Prevention ordered clinics and hospitals to give the shot only to high-risk patients. Kaiser didn't have enough patients who fit that criterion come forward to get their shots, Kashiwabara said.

"We had to throw away quite a bit of flu vaccine," she said.

Each year flu vaccines change, targeted at strains of the disease that pose the most danger. Last year's vaccine is not the same as this year's.

Meanwhile, the price of vaccine continues to rise: threefold, Kashiwabara said, in the past two years. "That's the drug industry," she said. "They know they have something you want and, well, I'm not saying they are gouging, but the price has gone up quite a bit. And we order in large bulk, nationally. I wouldn't even want to guess what others who can't buy like that would have to pay. A lot, I'd guess."

Even when healthy people are offered the vaccine, she said, a huge percentage will refuse. Kaiser has more than 225,000 members. Most will turn down the offer of getting stuck with a needle.

"It is always amazing to me how many people are shot-phobic," she said. "They'd rather live through body aches and other flu symptoms than get one."

This year, when she submitted Kaiser's orders in April or May, she requested only 60,000 doses and drew together a group of medical professionals called the "flu crew" to brainstorm ideas on how to get healthy people to get the shot.

They put notices on automated phone systems within Kaiser, and held walk-in shot clinics. "We just tried to make it really easy," she said.

When flu season started, the CDC and state Health Department also encouraged healthy people to get the shot. Although ordinary flu shots do not target potential threats like bird flu, having a lower rate of regular flu in the population could help curb the spread if the disease hits.

So with memories of shortages and bird-flu worries in mind, Kaiser members responded to the HMO's automated phone proddings, and lined up for the shot.

"Next year," Kashiwabara said, "I'm ordering more."

Reach Karen Blakeman at kblakeman@honoluluadvertiser.com.