Wednesday, October 21, 2009

H1N1: It All Becomes Real

Several months ago, I blogged about what I thought was going to happen when people who are used to getting what they want in health care were told that they couldn't get the H1N1 vaccine right away. That scenario completely failed to recognize the possibility that people actually wouldn't want the vaccine at all. It turns out that both are true. About half of the population does not intend to be vaccinated, and the other half is facing something of a shortage, at least in the short run.

Here in Washtenaw County, Michigan, the supply of vaccine is coming in slower than planned. This means that scheduled H1N1 vaccination clinics are being postponed or scaled back. My school district had intended to hold 3 clinics during the first 2 weeks of November and vaccinate anyone who wanted it. Today we got the word that one of those clinics was canceled and the other two would only vaccinate high priority subgroups.

This was, in almost all respects, a possibility I was prepared to deal with. I was not prepared, however, to deal with perhaps the hardest crisis communication audience I ever have to face: my daughter. My daughter is 11 and healthy. Her brother is 4. That means that he is a high priority for H1N1 vaccine, and she is in the next tier down. This means that, at the beginning of November, instead of the whole family going to the clinic for our vaccinations, we will just take my son.

My daughter has a mom who does crisis and crisis communication for a living. She's used to talking about some pretty heavy things around the dinner table, and to weighing some difficult ethical topics. She gets why my son gets the vaccine and she doesn't, at least intellectually. And yet, it's hard enough when your baby brother gets all the attention and the presents and gets away with everything and everyone says he's cute (at least that's how it seems sometimes). Now he is a higher priority for healthcare. This is a form of sibling rivalry few of us have experienced.

I am telling myself that I'm OK with not getting the vaccine right away, and with waiting to get it for my daughter. I also know we have two students at school who have secondary infections following presumed cases of H1N1. They are very sick, and they've been out for a long time. I know the numbers and the odds -- I write about them incessantly. But those two kids are much more real than all the numbers in the world, and I identify them much more with my own daughter. I'd be lying if I said I didn't want an extra dose, just for her.


Jess said...

Indeed, Naomi, a toughie. In the UK the first tier is even more limited and in fact the only one in our family who might qualify is me. Don't you have the same circumstance with Brian? Even harder when you feel like your kids remain at risk while you could get it. But here it is also weighing the risks of H1N1 vs. the vaccine with an adjuvant that is still experimental. The NHS does indeed make different decisions than the U.S. has.

Colleen said...

I've been trying to find out the relative risks of the flu vs risks of the vaccine. I cannot find the information!

Some of the people supposedly in the know say that it's the same vaccine procedure that they tweak for the seasonal flu, and some say it's not, but it's safe. IF it is the same, then is it as safe as the seasonal version? If it's not same vaccine, then how and when was it tested? Is it really as new as it appears, and if so, why do they think it's safe?

I can find the "report adverse reactions" stuff fairly's the only easy thing to find! Is that because they are really afraid of lots of reactions, and they want to be sure that people can report? Is it just really really bad web design (I suspect the latter....the most likely, or in this case, prevalent, reason is actually most likely to be true)

What are the risks of complications of h1n1 compared to seasonal flu?

If one can't compare these things, how can one make an informed decision? If one can't make an informed decision, one logical choice is clearly to go for the traditional, "first do no harm", and not do it...

Do they have information to suggest that the risks of this particular vaccine are fewer than the risks of complications of the flu? Where is it?

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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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