# 3366
It’s one thing to say we’ll have a vaccine in the fall, it is quite another to deliver it to the arms of millions of Americans.
During this time of economic recession, plunging tax revenues, and budget deficits - local health departments are going to be stressed to the max to deal with an influenza pandemic this fall.
First this article from Peoria, which is likely illustrative of many communities, then some discussion.
Swine flu vaccine will be costly to administer
By CLARE HOWARD
OF THE JOURNAL STAR
Posted Jun 18, 2009 @ 08:26 PM
PEORIA —
The Peoria City/County Health Department expects a $5.5 million cost for administration of swine flu vaccine this fall to about 186,000 people.
Greg Chance, public health administrator, told the board at its regular June meeting that the H1N1 flu vaccine will require refrigeration and likely will arrive at the department at the same time seasonal flu shots are being administered.
Logistics are further complicated because H1N1 vaccine is administered in two doses, 28 days apart. Chance said local health departments need the federal government to provide funding for the vaccine, but so far money has not been allocated through a health protection grant.
He termed the situation "a perfect storm."
The department expects a deficit budget in 2010 and is looking into offering voluntary separation agreements to its employees. There are currently 1.6 vacant positions, and the board passed a hiring freeze.
Logistics, as we’ve discussed many times, are always a big stumbling block when it comes to dealing with a pandemic.
In too many pandemic plans I see sections that offload broadly defined tasks to local governments and agencies, often without any guidance or help.
In one state plan I saw, there was a statement that local governments would be tasked with providing food deliveries to quarantined households.
It never said how that was to be done, who would pay for it, or even what agency would be responsible.
But at least the plan had that item `covered’.
In many of these plans, you really expect to see `and then a small miracle occurs’ in bold print inserted on about every other page.
Obviously, delegation of responsibilities and authority are important in any pandemic plan. But I suspect that many of these mandates are blind, unfunded missions, and are being ignored by local governments in the fervent hope that they will never actually be needed.
Often we read of health departments who hold vaccination drills, and over the course of several hours, run several hundred people through a vaccine queue.
These drills have value, of course, but they don’t really reflect the reality of a pandemic vaccination program.
Delivery of a pandemic vaccine to targeted members of a community, while in the middle of a pandemic, is a complex and resource intensive project.
Since no decision has been made as to who will receive this vaccine (it won’t be first-come, first serve as it was in 1976), it is hard to know how they will coordination a vaccination program.
Sure, Health Care Workers and first responders can probably be vaccinated at their workplaces and school-aged children at school . . . assuming their parents send them, or that schools aren’t closed.
But it gets complicated after that.
- But how do you get to pregnant women, another very high risk group? What proof of pregnancy will be required?
- How do you target other high risk groups or tiers?
- How do you keep someone from trying to `hurry up’ their immunity by returning in 1 week, instead of 4 weeks, for their second shot? Set appointments for a follow up shot?
- What kind of record keeping will be required?
- If the virus turns virulent and the demand vaccine is great, how do health departments handle security and crowd control?
And these are just a few of the challenges.
Added to this, health departments will be dealing with the same absenteeism issues that everyone else will during a pandemic.
At a time when the need for their services will be the greatest, it is possible they could be seeing 20%-30%-40% of their staff out sick, or taking care of sick loved ones.
All of this adds up to a large, unfunded mandate for local health departments. And a crushing workload, as well.
No decision has been made to deliver a vaccine to the public this fall, and that decision may not be made until late this summer.
We probably won’t know, until then, exactly who would be targeted to receive the vaccine – although I expect to see a lot of discussion over that in the coming months.
I’ve no doubt that somehow, most health departments will find ways to get the job done.
But that may come at the expense of other important services, and the stress and extra workload could exact a heavy toll on health department personnel.
While we may be able to flog this battered horse across the finish line one more time, we risk killing it in the process.
It is already hard to get people to go into the public health area. It is unfortunately viewed by many as unglamorous, underpaid, and unappreciated work in this country.
We need to change that image, and we need to do that now. And that means, first and foremost, allocating the money so they can do their jobs.
Otherwise, if we see anything more than a very mild pandemic this winter, we may find ourselves desperately looking for that small miracle to occur.
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