H1N1 report

H1N1 Vaccination—Lessons for the Future

By Sharon Fisher, 10-18-09

When I was a junior in high school, Gerald Ford was President, and amid fears of a swine flu epidemic, I joined thousands of other schoolchildren getting mass vaccinations. Honestly, at this point I don’t much remember the details; I get too mixed up with my memory of reading the vaccination scene in The Andromeda Strain, which I read about the same time. (I didn’t, incidentally, wind up with Guillain-Barré Syndrome.)

Now it’s 2009, Barack Obama is President, the swine flu epidemic is much more of a reality than in 1976, I have a fourth grader, and mass vaccinations are going on again.

My daughter and I live in Kuna. While mass vaccinations are scheduled for schoolchildren in Boise and Meridian, those of us in Kuna have heard nothing about any vaccinations in our schools. Grandma is on dialysis. Great Aunt is having chemotherapy. So keeping my daughter up on her vaccinations is important to me.

(I’m not going to get into whether you, or your kid, should get vaccinated. That’s up to you. I’m not a doctor.)

I’d heard that there was going to be a clinic in Nampa, at the empty Sportsmen’s Warehouse store near the relatively new Midland Ave. shopping center, so I figured we’d check it out. It started at 11 am; I arrived around noon, thinking that—with all I’d been hearing from people who said they didn’t want to be vaccinated—we’d saunter into the cavernous store, get vaccinated, and walk right out again.

That’s not how it worked out.

Even from the highway exit, I could see all the cars in the parking lot. As I approached, I could see the line, snaking across the front of the building and down a long stretch of sidewalk.

Well, it was a nice day, and she still needed the vaccination, so we got in the line. My daughter and I whiled away the time arguing about whether to get the mist or the shot. (She was in favor of the mist. I told her she’d get what we could get, but I’d try.)

Every once in a while, a staffer walked the line, asking whether we had any questions. How many people are in line? About 950. How long will it take? About an hour. (Later, they put up a sign, like at Disneyland: “The wait is two hours from this point.") Is it just for priority people? That’s what we’d prefer.

Like the other kids, my daughter started playing in the vacant lot that was destined, someday, to be a parking lot for stores yet unbuilt.  A wide variety of people were in line, ranging from tiny infants to people in their 90s who walked slowly and used folding chairs brought out by the staff to support themselves during the wait.  Community Emergency Response Team (CERT) members directed traffic and made sure people weren’t cutting in line. One of the guys I talked to said many more people had shown up than they’d expected.

After about an hour, the Q&A staffer was starting to say, well, vaccine is running low and it’s possible you won’t get in. But hey! No problem! We’re having another clinic next weekend! Surprisingly, we were unconsoled. Also, this guy said that they weren’t limiting it to priority groups, that anyone in line could get the vaccine.

Another half-hour later, we’d made it to the front of the building. Pregnant women—who’ve been warned to get vaccinated as soon as possible—were now told that they couldn’t get vaccinated at this clinic because the non-thimerosal version wasn’t available. (The Center for Disease Control website says thimerosal isn’t a problem for pregnant women.)

We were told that we would need to fill out paperwork, if we hadn’t already filled out paperwork we’d downloaded from the Internet?

Buh? This was news to me. That definitely would have saved some time. (Want the Southwest District form, which covers Canyon County, for yourself? It’s here. Want the Central District form, which covers Ada County? It’s here.)

So I filled out our forms—which didn’t ask whether we were in a priority group—for both of us. I wondered whether they’d give me a hard time for being from Kuna, but they didn’t mention anything; according to an article in the Idaho Press-Tribune, people showed up from as far away as Oregon, Twin Falls and Horseshoe Bend. The form also had us check whether we wanted mist or a shot. Much to my daughter’s delight, I checked “mist.” The mist is only for healthy people between 2 and 49; I was just six weeks under the ceiling for getting it. I also figured it would be quicker.

Ha.

So there we were in another line for the single table with mist vaccine. Several tables were set aside for families, so a group of part mist and part shot didn’t have to get split up, and several other tables for shots, where most of the older people and people with chronic diseases went.

Meanwhile, the media were there, looking for adorable little girls being vaccinated to put on the news. Several of them got filmed not long before us.

After the wait, the actual vaccination itself was anti-climactic. The provider, just as though she hadn’t already done it hundreds of times that day already, explained the process and patiently answered all our questions. There was no feeling of being rushed. Squirt squirt, dribble dribble, and we were done. (Being under 10, my daughter will have to go back in a month for a booster.) Other than sore feet from standing so long, there’s been no repercussions. (And, incidentally, according to the Press-Tribune article, the clinic ran out of shots but still had mist when they closed—my getting the mist, though I wasn’t in a priority group, did not deprive anyone else of being vaccinated.)

While people were largely patient and the process worked well, albeit slowly, one wonders what it would have been like had it been a cold or rainy day. It would have been nice to have a Porta Potty outside (CERT officials said they were planning that for next time). It would have been nice if there had been an express line for the aged and infirm. Which vaccination is appropriate for pregnant women needs to be worked out and consistent, as does the policy for priority groups.

There’s also the question of, if it took two-and-a-half hours to get vaccinated for H1N1, what would it have been like getting vaccinated for something more serious, such as a terrorist-spread smallpox or anthrax epidemic? One hopes that the CDC, as well as the Idaho public health districts, is looking at this as great practice for streamlining the process in the future.

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