Friday, November 06, 2009

Cross That Off the To Do List

As of 1 p.m. yesterday afternoon, my little family is as protected from the flu as we can be. Pumpkin got the second of her two H1N1 vaccine doses yesterday. Hubby and I had gotten ours last week (we qualify because we have a newborn in our house). We all got our seasonal flu shots last month.

Phew. I'm glad that's done.

I sure hope the people in charge of planning for pandemic avian flu have been paying attention, taking notes, and thinking about what we can do better, because I give our performance during the swine flu pandemic a C-minus at best.

On the plus side, a vaccine was produced and expedited through the necessary tests (and yes, I think it has had plenty of testing and is safe). A sensible plan for who should get priority access to the vaccine as it rolled off the production lines was put in place. Public health experts made valiant efforts to communicate the priorities and the reasons for those priorities.

On the negative side, the distribution of the vaccine has been unnecessarily confusing. I can only speak to what happened here in San Diego, but I don't necessarily mean this as a criticism of our San Diego authorities. My understanding from my inside sources is that some of the screwiest decisions were taken at a higher level of government. I have two main observations of things that could have been done better:

1. Once the vaccine started arriving in San Diego county, its availability was announced on the San Diego county website, and eventually, in the local media. The majority of the vaccine went to doctor's offices and clinics, not to the county's own public health clinics. However, the county's website and the media only reported the locations of the public health clinics- they didn't say where else the vaccine had gone. Not surprisingly, long lines formed at the public health clinics, since this was the only place we knew had the vaccine (I had checked with my doctors, and they did not have it).

If we wanted to rely on our usual vaccine distribution networks- i.e., people's primary care physicians- then more of an effort should have been made to make sure that most doctors got at least some vaccine. My family uses one of the big medical groups in San Diego, and some friends of ours use one of the other ones. Neither had any vaccine.

If we wanted to rely more on vaccination clinics, then the locations of all of those clinics should have been announced. My family was able to stand in long lines on multiple days only because I am out on maternity leave. Asking working parents to do that is just ridiculous. Yes, we all want to protect our kids from the flu. But we want to keep the jobs that allow us to feed and clothe them, too.

2. We needed to prioritize not just who got the vaccine, but who got each type of vaccine. Our public health department received far more of the FluMist (live, attenuated) vaccine than the shot. The FluMist is just as safe and effective for most people, but there is a lot of misinformation out there about it, so some people chose the shot even though they could have had the FluMist. This meant that they ran short of the shot and had to limit its distribution to just pregnant women, leaving children under 2 and people with chronic conditions (like asthma) with no options. I think they should have told people that if they met the criteria for the FluMist, that is what they were getting, and saved the more limited shot supplies for the people for whom FluMist is not an option.

We went to get Hubby and me vaccinated on the third day after a large batch of doses arrived (they arrived on Friday afternoon, and we waited until Monday so that we could send Pumpkin to day care and not try to wait in a two hour line with a toddler AND a newborn). While we were waiting in line, they announced that only FluMist would be available. Technically, I should have skipped the vaccination at that point. I have very mild asthma. However, getting me vaccinated (and getting antibodies into my breastmilk) was the only protection available to Petunia. I called a friend, who looked up what the concern was for asthmatics. It was that the live, attenuated vaccine might induce an asthma attack. I have never had a true asthma attack, so I made the decision to neglect to mention my asthma to the workers distributing the vaccine. This worked out fine for me (but I'm not advocating that anyone else do this!) but I shouldn't have even had to make that call. The perfectly healthy people who are listening to talk show hosts rather than medical authorities about what vaccines are safe should have been told that they could have the FluMist or nothing at all.

This particular virus is worrying for certain groups, but it is nothing compared to what could come eventually. I hope we learn from our "trial run" on pandemic management, and do better next time- when the stakes may be much higher.

8 comments:

  1. I am glad you were able to get the shots. They aren't available here for the public yet. Of course we came down with the flu this week so it may be a little too late for us. I hope you guys stay healthy!!

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  2. Bummer about the flu! We all have a cold- except for Petunia, which is amazing to me given how Pumpkin likes to "kiss" her and "hug" her (i.e., slobber on her and practically squash her). But its not a terribly bad cold, so I won't complain.

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  3. Have you read Does the Vaccine Matter? - The Atlantic (November 2009) http://www.theatlantic.com/doc/200911/brownlee-h1n1.
    He has a valid point. We give vaccines first to the elderly and immune compromised. Yet, it is not clear that vaccines would help us, as we might not be able to make antibodies, even with a vaccine.

    In the event of a shortage, it is more important to give the vaccines to healthy people we are in contact with, like our families and our child care and health care providers. Or to people who work with the public (instead of retired people who can stay home and away from disease vectors). But to say so publicly would subject us to ridicule and accusations of 'death panels for grandma'.

    Our entire family got the regular flu vaccine yesterday, but still haven't had the H1N1. Talk about bad planning and not giving vaccines to the people who need it the most, check out this fiasco:
    http://www.dailybreeze.com/ci_13637557

    Even getting the regular flu vaccine this year has been difficult. Our primary care doctors didn't have any. Our workplace canceled vaccinations at work because they couldn't obtain vaccines. My immunologist keeps getting short orders (she ordered 20 vials but they shipped her 5 each time) and they are gone in 1 day. Luckily, she gave one to my DH, even though he is healthy, in order to protect her patient, his immuno-compromised wife.

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  4. @badmomgoodmom- yeah, Hubby never got the flu shot until he started living with an asthmatic. Even with mild asthma, the flu knocks me out for weeks. We got the H1N1 vaccine primarily to protect Petunia, which, of course, is why we were even on the priority list. I think we got our priorities right this time- although there is some argument for just really targeting kids in school and day care as the little disease vectors that all parents know they are- but the distribution has been flawed. Health departments can't help the fact that there are shortages. But we don't seem to be doing a very good job of getting the vaccine distributed.

    Last I heard, our county health centers still have H1N1 FluMist for high priority people. Of course, that wouldn't help you (or your husband), since FluMist is not recommended for immune compromised people or the people who live with them.

    In a normal year, we have a hard time convincing people to get the plentiful, easily available flu shots. People die of the "regular" flu, too. I don't understand people. And don't even get me started on the fact that we have folks who are freaking out because they can't get the H1N1 shot and also have folks who won't vaccinate their kids against far worse diseases.

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  5. Glad that you all were able to get your shots. I'm impressed that your Pumpkin got her two doses! I think we'll be lucky to get our girl even one dose, and I hear it really doesn't do much to get just one dose. Our peditrician's office has received a very limited supply and are giving it to only the highest priority kids, which does not include our girl (even though she goes to pre-school and lives with a baby under 6 months, so you'd think...).

    I just can't find the shot anywhere where we adults would be able to get it! Since I'm back at work with almost all my leave used up (from my maternity leave), I can't take the time I'd need to go to figure out where I could get the shot anywhere close or take the time to wait in the long lines for it. We're concerned, but at this point just trying to practice good hygiene and limit exposure to sicknesses as much as we can.

    And I also hope that those in charge are paying attention and learning from this experience.

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  6. @caramama- personally, I'd get Pumpkin vaccinated if you can find the vaccine. You have to wait 28 days between doses, and by that time, more vaccine will probably be available. Also, I don't think they really know whether one dose will be any help at all- and it won't hurt.

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  7. Anonymous4:08 PM

    Yeah, I'm pregnant and STILL waiting to get vaccinated. The health dept seems to be the only place with supplies (which run out) and doesn't seem to prioritize very well. My employer (a big supplier) is also out. I work with lots of kids, too, many of whom have already gotten H1N1. I'm not a seasonal flu shot person, because I'm not in the high risk category (though we all got them last year when DS was a baby).

    Do they give FluMist to pregnant women, do you know?

    -Erin

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  8. @Erin, no, unfortunately, FluMist is not approved for pregnant women.

    One of my friends here found the H1N1 shot at Walgreens, of all places.

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