Since the beginning of October, local health departments across the state of Missouri have had little time to do anything but deal with the demands of responding to the H1N1 influenza outbreak. Activities have included using previously written pandemic preparedness plans to guide preparation for the arrival of H1N1 disease, H1N1 vaccines, and antiviral drugs.
The education and information efforts of health departments across the state, aided by local and national media, have successfully informed the public about novel H1N1 influenza, the risks associated with the disease, and steps to take to try to avoid being infected. One of the best sources for this type of Information is www.FightTheFluMO.com. The campaign was developed by the public information officers of several larger health departments in Missouri and supported by most of the 114 local public health departments in the state.
The next task was for health departments to begin to register vaccine providers in their county, such as doctors, hospitals, and schools. This involved making provider agreements and provider registration forms available to potential providers. In St. Charles County, we have registered 115 providers as of October 30. When this is complete, each provider could begin ordering vaccine using a special form that we made available. Those orders are held until vaccine is allocated.
As doses of vaccine become available each Wednesday, the Missouri Department of Health and Senior Services (DHSS) sends a spreadsheet showing the amount allocated of the five different formulations of H1N1 vaccine to each of the 114 local public health departments in the state. The health departments then look at the orders they have received from providers and order vaccine.
Two methods of getting vaccine to providers are being used in Missouri. The first method is to have each vaccine allocation shipped to the local health department. The health department then looks at the orders they have received and determines where vaccine should be distributed. Either the health department delivers the vaccine to providers selected for receiving part of that week’s allocation or providers come and pick up their allocation.
The second method, and the one being used in St. Charles County, is to select which providers should receive vaccine based on the urgency of the risk group, the population that the provider serves, and how many doses are available. In most cases, only partial orders can be filled. The local health department then sends the orders to DHSS for the selected providers and the vaccine is DIRECT SHIPPED to the provider by express shipping. This means that distribution is immediate.
So far the problems encountered have little to do with the process or which of the two methods of shipping is used. The problems have everything to do with the shortage of vaccine that is available for allocation to health departments. An inadequate vaccine supply is being allocated based on risk group to the extent possible. Unfortunately, there is not enough vaccine even to fulfill the needs of providers who care for high-risk patients, which include pregnant women, young children, and medical practitioners providing direct care to ill patients. Some of those providers have yet to receive any vaccine due to the shortage, and those that have gotten vaccine usually received less than they ordered.
I am writing this at the end of October. Hopefully, next month when I again write “From the Director,” the supply of available vaccine will have increased and many of these problems will be well on the way to being resolved. Until then our recommendation still is to:
- Follow the preventive steps in order to reduce your chance of being infected by the H1N1 virus (see www.FightTheFluMO.com, www.scchealth.org/swineflu or www.flu.gov for tips).
- Get vaccinated against the seasonal flu. You may have to look around in your area to find vaccine.
- Get the H1N1 vaccine WHEN IT BECOMES AVAILABLE TO YOU. Be aware that you may have to look around and that it may be a while.
We have been hearing from a lot of our citizens, and what we mostly hear is concern for their children and questions about when vaccine will be available. I know I speak for my fellow health directors in the 114 local health departments across Missouri when I say that we will work diligently to get the vaccine to you and your family as fast as we can.