Swine flu vaccine system raises anxiety

The U.S. government has put county health departments in charge of distributing the vaccine, and not everyone is happy about that.

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Ann Varady could be happier.

Varady, who lives in Milton-Freewater, has been a pharmacist for 30 years, with experience in Walla Walla and Hermiston box stores.

She is also a certified immunizer and dispenses vaccinations at the drug store where she works. Meaning, Varady feels, she and other pharmacists are on the front line of health-care providers for the flu season.

Specifically, swine flu, for which the federal government has dispatched nearly 6 million doses of the almost 8 million doses ordered as of last Wednesday.

Across the nation, county health departments have been given jurisdiction over the distribution of every single H1N1 dose by the Centers for Disease Control and Prevention.

And that's a sticking point for Varady.

Not only is Varady just across the pharmacy counter from sick customers all day, she's diabetic. "So I have underlying health conditions," she explained.

As well, the pharmacy she's employed at typically dispenses seasonal flu vaccinations. Customers depend on the store for that, Varady said.

But, like many others, the pharmacist has been told by Umatilla County health officials she and her pharmacy are going to have to wait -- Varady will be eventually vaccinated and her pharmacy will get a share of swine flu vaccine.

County health officials just can't say when.

Last week the wait got longer. The CDC announced the supply of H1N1 vaccine has yet to stabilize. Due to production problems the initial supply is likely to stay limited through November or longer.

Under those conditions, administrators in Walla Walla and Umatilla counties are striving to balance demand and supply.

In Walla Walla County alone, there are about 3,500 people falling under the heading of health-care provider.

"It's a little hard to get your arms around that," said Harvey Crowder, administrator for Walla Walla County Public Health Department.

Some in that number are "nose-to-nose" with patients while others can stay back a few feet. His job is to vaccinate the most vulnerable in the general population and to keep healthy those that keep the community healthy, he said.

With the arrival of the first of 600 doses, Crowder parceled out 200 to Providence St. Mary Medical Center, 100 each to Walla Walla General Hospital and Family Medical Center, and 200 to Walla Walla Clinic.

Last week, with a second allotment landing, he was able to get vaccine to some of the smaller, independent physician offices -- it was all destined for vaccinating people in the highest risk groups, he said.

Beyond that, Crowder retained 100 doses to begin vaccinating "the providers providing direct care."

Overall, Washington state had received about 80,000 H1N1 immunizations as of last Wednesday. Not nearly enough to cover the five high-risk groups, health experts say.

There is no doubt professionals such as dentists and pharmacists, like Varady, are in the line of fire in the swine flu battle, Crowder agreed, and they will get vaccinated. "I wish I could cover the world ... it's not a simple solution."

At some point every health department in the country will have more vaccine than they've ever had, he added.

"Right now," however, "it's murky at best."

For Gennie Lehnert, this flu season is a similar story. The Umatilla County Health administrator is dealing with a swine flu vaccine supply coming "in dribs and drabs."

It's been in the form of the nasal mist so far, and only approved for children and adults age 25 to 64 with underlying, chronic health problems.

How to parcel out the early doses is not a decision Lehnert made on her own. After two weeks of meetings, a group that included officials from area hospitals, a pediatrician and a county commissioner decided to send Umatilla County's first arrival of 400 doses to hospitals and pediatricians. Shipping the county's share of vaccination to private providers would "completely overwhelm" those offices, Lehnert explained.

"I'd like to vaccinate everyone now. The reality is, how can we best reach the five priority groups while preparing to do mass vaccination clinics?"

Her department easily gets 100 calls a day from people anxious for information and hoping for the magic answer, Lehnert said. "This is not a happy place to be in for me."

In the meantime, Umatilla County Public Health is storing some of the vaccine arriving in preparation for the upcoming mass shot clinics, scheduled for Dec. 1 in Milton-Freewater and Dec. 19 in Pendleton.

"Thirty-three percent of our county residents do not have primary care providers or health insurance. We want to be sure to vaccinate those who won't be able to afford to get vaccinated," said Sharon Waldern, clinic nurse supervisor.

She disagrees with that decision to stash vaccine, Varady said. "Why withhold vaccine until mass vaccinations when we have reported cases and deaths within the county?"

Asking residents and many health-care providers to wait for such clinics when vaccine is available now seems counterintuitive, the pharmacist added. "It's rampant. Why are we waiting?"

To make everything even more difficult, next week's H1N1 vaccine supply is half of what was expected to come, Waldern said, adding that public health officials in Oregon will be conferencing today on what steps to take for the shortfall.

"We are not going to please everybody," Lehnert conceded. "I know that. But we are doing the best we can."

Keeping distribution equitable is what he gets paid to do, Crowder said, So far, he hasn't encountered anything he would label a bribe in return for an unauthorized swine flu vaccination.

"But they sure have tried to sweet talk me."

Who's in charge

County health departments are in the "driver's seat" for swine flu vaccine distribution this year, noted Grant Higginson, public health officer for the state of Oregon.

The formula used to decide how much vaccine each county gets resembles a trip up and down the ladder with a couple of sideways steps.

The Centers for Disease Control and Prevention get notice from drug manufacturers how much vaccine is expected to be produced and when it will be ready to ship. Next, states are notified how much each will be allotted -- done through some "equitable formula," Higginson said. "Then we look at each county and see who is expected to be in the high-risk groups."

At that point, the county lets the state know those numbers and the state sends that information back to the CDC.

County health departments can decide to keep control of the vaccine or use immunization partners, such as retail pharmacies, which must register with the state to receive and dispense swine flu vaccine, Higginson said.

As of Friday, Oregon counties had received about 80,000 doses to begin making a dent in its case load of 2 million or so high-risk residents.

Once those folks are immunized, the door will open for additional populations, he added.

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