Monday, October 5, 2009

The H1N1 Vaccine

The H1N1 vaccine began being shipped today.  The nasal spray version (which is only for patients ages 2-49) is being given started today, and the injectable version should begin to be available later this week.  I want to say at the outset that it is none of my business whether you choose to get the vaccine or to immunize your children.  I would not presume to make that decision for someone else -- it is between you and your doctor -- and I would hope that others would give me that same courtesy.

I do, however, have a particular interest in how the roll-out is being handled, and some interesting patterns are already beginning to emerge.  There seem to be three major issues rearing their heads:

1) People want the vaccine who cannot yet get it.
A story in today's New York Times indicates that doctors in the New York area -- and I doubt they are alone -- are getting swamped with calls from patients wanting the vaccine for themselves or their children.  But the vaccine is not available to the general public, and what's more, the people who are calling for it are not going to be getting it in the first wave.  If they think they can get it now, I can't imagine they're going to be thrilled when their doctor's office actually has it and they still can't get it.

2) The system for getting the vaccine is a mystery to most people, including doctors.
Did you know that the vaccine is free?  On the other hand, did you know that if you get it from your local health department you probably won't pay at all, but if you get it for your doctor you (or your insurance) may pay for the administration of the injection but not the vaccine itself?  The public health strategy is to get as many different places administering the vaccine as possible, but because when it will be available is somewhat up in the air, there is no systematic process for making sure that the people who need it all get it.  Ironically, our health care system is ill prepared to use its non-single-payer structure to administer a single-payer vaccine.

3) There isn't a single, strong, systematic message about the vaccine coming from the government.
There are a number of conspiracy theories out there, which I won't bother going into.  There is also a fair amount of misinformation (e.g. you can get the flu from the shot) in addition to some legitimate questions (e.g. has the shot been adequately tested?  Are manufacturers responsible for the safety of the vaccine?) that are being raised.  While there are public officials addressing these things as they come up, no one seems to be anticipating the controversy and trying to give a coherent, comprehensive message about the vaccine, its importance and its safety.

I think what has happened here is that we had a pandemic flu plan for a deadly flu strain.  We imagined what it would take to get vaccine manufactured and out to the public to save thousands or hundreds of thousands of lives.  What we didn't plan for was a pandemic of a fairly ordinary strain.  As one commentator on the New York Times website said today, the difference is not the virus, it's the epidemiology of the virus.  We did not anticipate having to convince people to get vaccinated.  If this were killing the way the 1918 flu did, few people would resist vaccination.  The government is way behind in its ability to talk to the American people intelligently about this vaccine.

In my school district, what started as a discussion of having children vaccinated during the school day has changed to a plan to hold three clinics in the district after hours for children and families.  That is probably just as well -- the thought of immunizing children with an injection during school made staff's blood pressure go through the roof.  My analogy was that this would be just like picture day, only with pain.  What a logistical nightmare.  Even the limited clinics that we have planned are controversial for some.

Again, it is none of my business whether people vaccinate themselves or their children.  I just think that, if the government wants people to get vaccinated, they need to make it much simpler to do and easier to understand why they think you should do it, or a lot of people will be lost to poor information and logistical hassles.


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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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