Monday, December 7, 2009

Swine Flu Blues… Part Two 12/7/09

I just got this interesting Email from my State Health Dept. about the scarce H1N1 vaccine.

See my comments in italics;

The Pennsylvania Department of Health has received information from across the commonwealth that indicates many of the individuals in the Centers for Disease Control and Prevention’s (CDC) five priority groups have received the H1N1 vaccine. As a result, the Pennsylvania Department of Health will soon be expanding availability of H1N1 vaccine to any individual who wishes to receive it, even though we will continue to actively encourage persons in the five priority groups to receive it if they have not yet been vaccinated.

Interesting!!! Where are you (The PA Dept of Health) getting your information/ reports?

We just had our family practice department meeting 12/1/09 at our local hospital. Only a small percentage of the primary care doctors had themselves received a dose of the vaccine, primarily from occupational health at the affiliated hospital. There has been no vaccine available for their “at risk” family members, office staff or the vast majority of their patients.

Most of the physician practices that requested and registered for the vaccine months ago (about half the offices) have not received any vaccine, or notification of when or whether they will get any vaccine from the State distribution center PASIIS. When I called PASIIS earlier this week I was told that they did not know if or when I might receive any of the vaccine that I ordered for my practice months ago. I was only told that I would likely get an email from the distributor about 3 days prior to receiving a shipment if my practice was selected to get a supply of the vaccine.

In reality only one family practice office (that I know of) in my county got any vaccine. It just so happens that they are one of the two practices in the county that is designated by the State to do influenza nasal culture surveillance of patients with Flu like illness. Our local State funded Community Health Center had H1N1 vaccine available only for their indigent patients. The Chester County Department of Health has some vaccine from time to time.

I am a Board member of the Chester County Department of Health myself, but was unable to arrange a vaccine for myself or my at risk family members. When I called last week I was told to call back periodically to see when more vaccine became available. Due to scarcity, it would then be distributed on a first call when in stock, first scheduled protocol.

Unfortunately, most of my at risk patients didn’t have the time or knowledge to contact them and register on their web site or call to schedule an appointment to get the vaccine. Currently, due to the scarcity of vaccine allotments from the State and limited staffing, they are scheduling appointments for H1N1 vaccine in 5-6 weeks, well into the New Year.

A patient of mine is the Principal of a large elementary and middle school in my county. She is totally frustrated that after working diligently with the County and State Health Departments for months, that her board denied distributing H1N1 at their facilities due to “liability concerns.” She assumes that few if any of the at risk pupils have or will ever get a dose of H1N1 vaccine.

So, it is very interesting to hear from the powers that be in the State Health Department that so “many of the high risk candidates state wide have received vaccine” that those facilities who currently have vaccine can give their doses to whomever asks for it regardless of risk.

I can only surmise that the “information received from across the commonwealth” has come from employees of County and State run distribution centers that don’t cater to the same patient populations as community based physician practices. I am also sure that demand has been low within these State and County run facilities due to the non consumer friendly manner in which the vaccines have been distributed.

So, Happy Holidays to my at risk children, wife, at risk office staff and all of my at risk patients. We are not and likely won’t get the H1N1 vaccine in 2009 nor likely in 2010. I got my vaccine dose at my hospital's occupational health department as a good doctor should but have no access to vaccine for all those others I care for at risk.

The Department will be taking this step because we anticipate significant increases in the amount of vaccine allocated to Pennsylvania in the coming weeks. However, before the offer of vaccine is extended beyond the five ACIP priority groups, the Department of Health thinks it is important to assure that health care facilities and other providers are provided the opportunity to complete vaccination of their priority populations.

If you are a certified provider and have not yet received H1N1 vaccine, or sufficient doses to complete your program, please provide us with the number of doses you still require to assure vaccination of your patients in the five priority groups. To do this, you do not need to formally place an order for additional vaccine.

If you have completed your vaccination activities among the priority groups and still have remaining doses, the Department suggests that you now begin to use these doses to vaccinate persons outside of the priority groups.

Please contact the Department of Health by email at with the name of the facility, which ACIP priority group served, contact person and phone number, and number of doses needed.

When the community based doctor’s offices that placed our orders for the H1N1 vaccine a few months ago, we estimated or exactly counted the number of our patients who were in the at risk categories and based our order based on these numbers. We assumed we would get priority shipment of vaccine. Since the allocation of vaccine has been seemingly political or random at best, it is very difficult to know how many of our patients received vaccination at their schools, at State and County health centers etc.

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