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Story from the Field: LHD Takes on Distributor Role

March 10, 2010

New Role Calls for New Resources

During the H1N1 pandemic, the Centers for Disease Control and Prevention (CDC) and health departments were tasked with distributing vaccine to where it was needed most. In spite of this daunting task, and faced with delays in vaccine manufacturing and delivery, efficient systems of storage and distribution were put in place.

The Wright County Department of Health in Minnesota was successful in finding efficient means of both storing and distributing the vaccine using all resources available, from computer spreadsheets to a closed-down jail facility. By communicating with clinics and hospitals, and using spreadsheets to keep a running tally of distribution numbers, health officials there were able to distribute doses of vaccine equally among the 117,000 county residents.

In September of last year, questions arose over exactly how the vaccine distribution would work. At the same time, the distribution itself got off to a slow start with early projections and estimates uncovered as overly optimistic.

“We wanted to have equal distribution and therefore equal availability of vaccine in our county, so we chose to have all vaccine delivered to us and redistributed by us,” said Carol Schefers, director of Wright County Public Health. “This was an awesome task that we had never planned to take on, and many lessons were learned.”

Perhaps most remarkably, since the health department had not been required to store vaccine before, they had to use a closed-down jail facility as a storage unit. A fridge in the jail was turned back on in order to serve as a storage place, and the facility was kept on lock down so that only local health officials could access the vaccine.

Collaborating to Overcome Problems

Like other health departments across the country, Wright County was affected by delays in vaccine delivery, but officials were able to resolve and communicate the issue. After receiving an unexpectedly low number of vaccine doses for their first mass clinics, the LHD immediately shifted focus. Working with the area’s hospitals and clinics, they agreed to offer the vaccine only to pregnant women and small children. Information about the clinics was relayed through a public hotline and the LHD’s Web site.

A positive outcome of the health department’s efforts has been the banding together of stakeholders in the county’s health industry. The county’s hospitals, clinics and public health officials worked together closely during the pivotal moments of the decision-making process.

“The ties that we forged with the hospitals and clinics will keep us together in any kind of a medical emergency,” said Schefers. “We had strong ties before this emergency, but this only strengthened them. We all listened to each other and there was not competition for vaccine—just a goal to keep our community healthy.”

In some ways, the H1N1 pandemic was a trial of public health preparedness and response capabilities. Recently, there has been some bemoaning over how slowly vaccine was distributed when demand was high. During a conference at the Center for Biosecurity at the University of Pittsburgh Medical School, Dr. Nicole Lurie shared her regret over the delays in delivery of the H1N1 vaccine last fall.

"The truth is for this pandemic we had about the longest warning we might ever have for a potential biothreat," said Dr. Nicole Lurie, who heads preparedness at the Health and Human Services Department (HHS). "And yet we all lament how long it took for vaccine to be made.”

The government is investing in more advanced vaccine production technology in order to avoid such delays in any future public health emergencies.

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Comments about this post

Carl Rachel
Congratulations to Carol Schefers and the Wright County Public Health team. I, too, work at the county level here in Hunterdon New Jersey. As the media/public relations director, I am charged with keeping the area population in tune and in step with the quickly changing dynamics of public health emergencies and the politics driving public health, itself.

At the county/local level, we are at the true "front lines" of public health. Only from this perspective can one clearly see the end game of the tidal forces at work in the federal/state government complex.

While blame slinging and credit snatching run rampant through the halls of higher government, honest-to-goodness "ownership" happens here, in the counties and towns of the U.S. Here is where the slicing arc of distant policymaking burns hottest.

The continuing conundrum of vaccine production limits, vaccine distribution challenges, and vaccine "acceptance" attitudes by the public can be solved in one way, but it takes courage.

The federal government must step up to the plate without a batting helmet concealing its true identity and shielding it from the risk of a wild pitching public to FUND PUBLIC HEALTH RESPONSIBLY. A wreckless, protracted history of underfunding is at the very core of both the latent and the urgent certitudes plaguing public health.

The H1N1 pandemic has clearly exposed the threadbare fragility of a system that will, in the end, either save lives or squander the opportunity to do so by standing on the deck of the sinking ship dysfunctionally debating how best to swim.

To my brothers and sisters on the front lines of public health, you have my utmost respect.

Carl Rachel
Director--Media/Public Relations & Strategic Communications
Hunterdon County Department of Health