Is an ounce of prevention taking a pound of cure out of the pharmacy?

WHAT IT MEANS AND WHY IT'S IMPORTANT — More people had gotten their influenza vaccine by November 2011 than they had by November 2010, according to the Centers for Disease Control and Prevention, and last year's triumvirate virus was a good match for the predominant flu strains in circulation. All of this leads into the lowest flu season on record, and that begs the question: As more retailers continue to build out their vaccination programs, particularly using the influenza vaccine as a potential gateway to its more comprehensive vaccine offerings, are they sacrificing their cough-cold sales to make that happen?

(THE NEWS: CDC: 2011-2012 influenza season lowest on record. For the full story, click here.)

The answer, in fact, might be yes. "I do think, in fact, that as vaccine coverage increases, we ought to see less disease in the United States," said Joseph Bresee, chief of the epidemiology prevention branch at the CDC’s Influenza Division during a wrap-up with reporters on the 2011-2012 season. "So I think although this season has been mild and the onset has been late and that can’t be attributed solely to vaccine practices, I do think increasing vaccine coverage in the United States will certainly — and probably is certainly — playing a role in less transmission and less disease this year," he said. "Second, what we know, and as I said, the vaccine coverage rates continue to trend upward. That should lead to less transmission over time and less severe disease over time, especially if high-risk people continue to get vaccinated in higher numbers."

The reality is a little more convoluted, of course. Even as flu vaccines expand, those vaccines have no impact on rhinoviruses, which is the cause behind the common cold. And that means, theoretically at least, you can have a low incidence of flu in a season and yet still a high incidence of the common cold.

And even coming out of the lowest flu season on record, trailing 52-week sales of cough-cold remedies were still up in food, drug and mass (without Walmart) some 5% across both liquid and tablet remedies. In liquids, Procter & Gamble's Vicks Nyquil was up 3.9% to $111.6 million for the 52 weeks ended April 15, while Reckitt Benkiser, which launched Mucinex Fast Max in the past year, realized sales increases of 330.9% to $53.6 million across its Mucinex liquid offerings (data courtesy SymphonyIRI Group).

Those cough-cold remedies also include allergy, more of a year-round ailment, as evidenced by the strong performance of the allergy remedy Allegra that predominated cough-cold tablet sales — up 506.9% to $182.6 million.

But the question remains: Does a stronger position in influenza vaccine at retail mean taking a hit in both pharmaceutical (antibiotics for upper respiratory bacterial infections and antivirals for the flu) and nonprescription upper respiratory remedies? Don't get us wrong: Flu shots, and vaccinations in general, are important to community pharmacy, both in terms of the public health role and in terms of generating new sources of revenue for pharmacy beyond dispensing. But the OTC sales related to cough-cold remedies is an important part community pharmacy's present and future, too. Is that ounce of prevention taking a pound of cure out of the pharmacy?

What do you think? Is there some risk in shifting from a sick care to a well care model? Will that change the merchandise mix someday? Post your comments below.