As state officials work to administer a mass distribution of the H1N1 vaccine during the winter flu season, some health care providers are concerned they have not yet received sufficient doses of the vaccine. They say the distribution process should be streamlined.
Demand, Shortages Vary
Rahul Gupta, executive director of the Kanawha-Charleston Health Department in West Virginia, says state officials remain concerned about vaccination supply and delivery.
“Many states are now in the planning stages to get the vaccine out to their providers in the next few weeks,” said Gupta. “However, the challenge now will be whether the vaccine supply will truly increase as repeatedly stated by federal officials and if the providers remaining interested sign up for the vaccine as current peaks of disease activity seem to have leveled off. Another factor is that many providers are on the fence whether to sign up to get the vaccine. For these folks, their patients need to provide them feedback whether they want their provider to carry the vaccine.”
Although more than 550 health-care providers have signed up to become swine flu vaccine administrators across West Virginia, and 375,800 doses of vaccine had been shipped as of the beginning of December, the arrival of the traditional flu season has prompted renewed worries.
Gupta believes the challenge for various state and local health departments throughout the country has been matching the limited and often unpredictable supply to their most vulnerable populations without irritating the masses.
“The vaccine shortage is being felt throughout most states,” said Gupta. “Most health departments are working with other partners like school systems, hospitals, and health care providers providing care to target group populations to accomplish the goal of offering vaccinations to the identified approximately 154 million people as the vaccine continues to trickle in.”
Initial Effort Insufficient
States are being allocated the vaccine based on total population, meaning shortages could vary based on other factors. Arleen Porcell-Pharr, a public affairs specialist at the Centers for Disease Control (CDC), concedes the initial government response failed to meet demand and a streamlined process could help.
“The process we use to make flu vaccine can be unpredictable and time-consuming,” said Porcell-Pharr. “Despite working around the clock, our response was not fast enough to meet the demand. States needed many more doses ready for shipping than could be produced with the egg-based technology.”
Communication Lacking
Gupta says health care providers who are not pediatricians or OB-GYN doctors are less likely to have received shipments. He believes a missing component is a centralized communication tool empowering providers and patients.
“There needs to be a centralized registration process along with a local ordering process. In other words, the providers can go thru the Medicare Web site to register online in their state chapter. Once it’s done and they receive the confirmation, they can take the printout to their local health department and work with them to place direct orders for their offices. This way the process would be fair, uniform, and much quicker,” said Gupta.
“Some states and local health departments may be able to manage this limited supply of the vaccine better than others, and there is no good system in place to check that,” Gupta added.
Gupta believes this method would avoid duplication across all fifty states, while enabling every American to check which doctor in their neighborhood is registered to get the vaccine.
States Have Responsibility
According to Christopher Cox, a spokesman for the CDC in Atlanta, GA, decisions about distribution are made at the local level.
“The federal government allocates H1N1 vaccine on a pro rata basis determined by population size of the state. State health departments and some big city health departments then make decisions about how to distribute vaccine equitably and efficiently within their jurisdictions,” said Cox.
“The vaccine development process is complex, and forecasting how much vaccine will be available at a certain time and place is challenging. However, providers in all states and locales are encouraged to ensure that priority groups—such as health care workers—receive the vaccine before it is made more widely available,” he added.
Since each state is responsible for distribution within its jurisdiction, Cox argues West Virginia is responsible for its reported problems.
“While states are in the best position to address demand for H1N1 vaccination in their jurisdiction, accounting for demand across diverse areas and populations is a complicated and imprecise process,” Cox said. “Coupled with the challenges inherent with vaccine distribution, providers may at times experience demand that outpaces the supply on hand.”
Lessons to Be Learned
Gupta believes the current failures to meet demand are worth studying for the future and that federal officials must listen to providers as they design distribution processes.
“There are many lessons to be learnt from this year’s H1N1 vaccination campaign at all levels of government. The most important is to take feedback from local governments, since this is where the rubber meets the road,” said Gupta.
“What we need going forward are folks who understand what programs are working and which ones aren’t. There is a ton of ‘lessons learned’ already at the local level from people who are in the field actually carrying out this campaign. The question is whether anyone is willing to listen at the state and federal level.”
Tabassum Rahmani ([email protected]) writes from Dublin, California.
