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Short Supply, Shorter Tempers

October 26, 2009

On Saturday, public health officials in Portland, like those in many other cities, held public vaccination clinics to administer immunizations against the H1N1 (2009) virus commonly known as swine flu.  The clinic, scheduled to open at 10.00am and close at 2.00pm, was practically inundated by anxious patients seeking protection against the ongoing pandemic.

Hundreds of people were turned away due to the short supply of vaccine available.  Frustration and hostility were limited but nonetheless very evident.  Trust for public officials was the only thing in shorter supply than H1N1 vaccine.

People began queuing for the clinic as early as 6.00am.  The last dose of vaccine — out of 500 available for dispensing at this site — was not administered until after 3.30pm.  Many of those who received vaccine literally waited on line for several hours.  And most who made it through the ordeal were incredibly grateful and gracious toward the public health staff despite the long wait outdoors.

Although originally planned in partnership with the local African-American community as an outreach effort focused on vulnerable pregnant women, children under five years of age and their caregivers, and those with underlying medical conditions who live close to the host facility, the clinic attracted a very diverse attendance from across the metropolitan area.  Among those seeking vaccination were a surprisingly large number of insured patients.

In light of the current debate about health insurance reform and access to care, this comes as something of a surprise.  Nearly everyone I spoke with indicated that they had been trying unsuccessfully to get vaccinated by their primary care physician, and resorted to the public clinic after hearing repeated warnings about the risk.

This illustrates one of the central problems of the current situation.  The message is getting through, but the vaccine isn’t.

Nearly everyone who showed up on Saturday fell into one or more of the at-risk groups designated by CDC as a priority for vaccination.  They knew the value of getting vaccinated, but could not access the vaccine not only because supplies have fallen far short of expected delivery schedules due to production difficulties, but also because the available supplies passed on to health care providers are not yet making it to patients in significant numbers.

This begs the question: “Where are they going then?”  Most health systems were distributing vaccine to their staff.  It makes sense to take care of those who we will rely on to take care of us.  But is this really what’s happening?  And, if so, why haven’t health care providers made this strategy clear to the public?

In the absence of information about how vaccine supplies are being used, people are left to fear the worst.  Their reasoning is simple, clear, and counter-productive: 1) I am at high-risk, 2) vaccine supplies are limited, 3) those supplies that are available are targeted toward people like me, 4) I have been unable to access service despite repeated attempts, 5) people are now getting sick in greater numbers, so 5) I must be at increased risk.

Public information efforts and administrative decision-making must now focus on the problem this situation has produced.  Where is the limited supply of vaccine going and what are we going to do to make sure it gets where its needed most?

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