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Story from the Field

Name of Health Department/Agency: New York City Department of Health
State: NY
Date Added: 03/10/2010
Themes: Vaccine Planning and Administration
Issue Summary: Using Corporate Health Sites for H1N1 Vaccinations in New York City
Description of Issue(s):


We didn’t actually do any specific recruitment for the employee health sites for H1N1 vaccination. We did more broad recruitment for all of the adult vaccinators and providers throughout the city. We have a lot of different mechanisms for reaching doctors, including sending mailings out to our list of providers who have medical licenses in New York. The other way that we get the employee health sites in businesses on these mailing lists is that we had done a lot of preparedness work with them in general for the pan flu preparedness. So, we had listservs and ways to contact them through that mechanism as well as through our HealthAlert Network. When providers were enrolling for H1N1 vaccine, on our enrollment form we did ask about whether they were an occupational health or employee health site. We did not actually have this as a category for corporate health.

Actions taken to address the issue(s): That was one of the lessons learned?we should have had that corporate health category. We really treated all of these sites as the same adult practice and gave them all the same code, which limited our ability to differentiate who was corporate health from just employee health or occupational health. Everyone who got H1N1 vaccine did need to sign their provider agreement as was done across the country. We had a lot more detail in our provider agreement. That ended up being a real lifesaver in terms of making sure that people were not giving vaccine to executives but were really adhering to the priority groups for H1N1 vaccine. We did review some of the memos that the corporate health clinics had given to their employees and I have to say that they were really great in terms of being very clear about only vaccinating the high-risk people. Overall, we had 74 sites that were registered with us, either employee or occupational health or corporate health. These really got mixed up to be a number of different sites and again this just goes back to the original classification scheme that we used. Out of these 74 sites, really only 36 were what I would call ?corporate health.? There was a fascinating range of people. We had the Racing Association, publishing, and then the vast majority financial institutions. Fourteen were hospital employee health clinics, who actually ordered separately from their main hospital pharmacy. There were five mass vaccinators that registered as employee corporate health. Then there were a smattering of others, such as the American Cancer Society, some union health centers, and 13 employee health sites that included our utilities, transit, fire department, police department, as well as our department of corrections. We do know that this is really an underestimate because many sites that ended up being corporate health, the physician registered them as a private practice. So there may be even more that we don?t know about that fell into that category. There were a number of mass vaccinators which once the priority group restrictions were lifted for the H1N1 vaccine, were doing a lot of clinics at different corporate sites. So again, I?m sure that the number of corporate health sites is much higher.

I think our major challenge was identifying what was really corporate heath. I imagine they wouldn?t necessarily self-identify. Again, we treated them as adult practices and I think some of them got vaccine early because we had the CSL product, which was only good for adults. So even though we were trying to stick to our prioritization?hospitals employees targeting health care workers?we did end up getting a couple of adult sites in there.

That?s really where the Goldman Sachs issue came up. At the end of October, there was a story about executives being vaccinated before other priority groups. It?s unfortunate the way the story unfolded because Goldman Sachs was adhering to the priority groups. They had received 200 doses, which is really a fraction of all the vaccine we had. There was no story there except Goldman Sachs was taking a hit in terms of the economic situation. What really saved us was that provider agreement that in fact Goldman Sachs didn?t receive any special treatment and had to go through the same process that the rest of all the medical facilities that were getting vaccine went through. These financial institutions are the large employers in New York City so they ended up being really important sites for us to reach high-risk adults. Certainly most of us do promote employee health clinics and it is their best practice for flu vaccine. I think that story actually got lost in all the publicity around corporate health getting vaccine. We do think that they followed their guidelines. I don?t think that they?ve done any better than other sites in terms of vaccinating.

Outcomes that resulted from actions taken: In all, the 36 corporate sites ordered 41,400 and received just about half of that?22,000 doses. They?ve actually reported to us about 24 percent of their doses, which is about the same rate of reporting that we?re seeing from the other providers. Some of them have asked to be resupplied with vaccine. Although as with all of us, they?re just not getting tremendous uptake at this point. So to close, we know that they?re continuing to expand mass vaccinators at the corporate health sites. Once the story broke for Goldman Sachs, a few of the corporations called and cancelled their orders. I think that was an unfortunate side effect of the story because there were likely people who would have gotten vaccinated who didn?t have any access to it.

Our lessons learned were to capture this information at the beginning. Then we didn?t think about the political aspects when we started sending out vaccine but certainly that was important.

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