More Details About the H1N1 Vaccine Distribution Program

By the end of this week, more than 660,000 doses of H1N1 vaccine will have been distributed to providers in Massachusetts – just the tip of the iceberg of the total 3.5 million doses of vaccine that we expect to receive this flu season. However, to put things in perspective, those 660,000 doses are enough to vaccinate just 10% of the state’s population. This is not where we expected to be at this point, based on what we were initially told by the federal government, and it creates a difficult and frustrating situation for everyone, especially those people at greatest risk of complications from the H1N1 flu.

These initial limited supplies have been prioritized for distribution to the health care providers who serve the populations at the highest risk of H1N1 flu – pregnant women, children, and caregivers of infants less than 6 months old. It has also been prioritized for health care workers with direct patient contact in light of their vital role in keeping the health care system working.  DPH believes this targeted distribution approach, using health care providers who serve these high risk groups every day, is the most effective way to ensure the vaccine gets to those who need it most as quickly as possible.
 
As vaccine supplies arrive in larger quantities, more and more providers will receive vaccine for their patients.  Vaccine will then be targeted to young adults up to 24 years old and people 25-64 with chronic health problems.  Eventually, flu clinics for the general public will begin.  However, they won’t be scheduled until there are large enough quantities of vaccine available to support them. Based on current projections from the Centers for Disease Control, these flu clinics will not likely be feasible until December. When they have been scheduled, you can find one near you at http://flu.masspro.org.  It is important to note that no H1N1 clinics are listed at this time because there is not enough vaccine to run them.

This vaccine supply situation is complex and confusing.  We continue to receive requests for further details on how vaccine arrives in the state, the role of DPH in that process, and how providers receive word on upcoming vaccine availability.  Here’s how the system works:

There are 9 different vaccine formulations approved for various age groups. Vaccine comes as thimerisol-free prefilled syringes, multidose vials with thimerisol, and live, attenuated virus nasal spray (Flumist). So, the doses of vaccine are not interchangeable.  They can only be used for the groups they were made and approved for.  More detailed information is available on this chart.

When a provider first registers with DPH to receive H1N1 vaccine, they include key details about their practice, including:
• Type of practice and target patient population served
• Capacity to vaccinate (how many people could they vaccinate in a month with sufficient vaccine supplies)
• Whether they are willing to receive live attenuated vaccine formulations (e.g., Flumist vaccine)
• How much vaccine and which formulations they would like to order

Several times each week, DPH receives notice about how much newly available vaccine, in which formulations, we can expect to receive. We use the details provided to our vaccine registration system to figure out where that vaccine should be shipped. For instance, pregnant women can’t take Flumist, so if the only vaccine available is Flumist, we cannot send that new quantity to OB/GYNs. It can however, be administered to healthy children, and would therefore be sent to pediatricians.

DPH does not play any role in physically receiving and redistributing H1N1 vaccines, which are shipped directly to providers in the community. However DPH does play a vital role in matching up available formulations to appropriate providers as vaccine comes off the production line.

There are more than 4,000 health care providers in Massachusetts that have signed up with DPH to receive H1N1 vaccine this year. (The actual number of vaccination sites is higher, because some of the larger providers will further distribute their allocations of vaccine to their affiliated provider locations.) Virtually all of the providers that serve the priority groups have received some amount of vaccine and will receive more in the coming weeks.  However, very few have received all of the vaccine that they wanted because we just have not gotten enough vaccine yet.

Unfortunately, the vaccine supply is unpredictable during these early days of distribution and at this time, the state does not have enough vaccine for everyone in the highest priority groups.  Massachusetts has 3.4 million residents that fall into one of the target groups for H1N1 vaccine because of the age, health status or because they could transmit the virus to infants younger than 6 months of age or to vulnerable patients.  Thus, it is possible that a pregnant woman with an underlying health condition may not be able to get vaccinated right away.  As more vaccine becomes available in all of the various formulations, these allocations will even out, and all pregnant women that wish to be vaccinated can be.

Understandably, given the delays in receiving large quantities of vaccine, people want to know exactly where the vaccine has been shipped.  We have received requests for specific information about which providers have how much of which formulations at any given time. This information is difficult to accurately convey as the situation is constantly evolving. Even if it were easy to describe, releasing that detailed information would likely result in an overwhelming surge of calls and visits to providers, preventing them from quickly and efficiently dispensing the vaccine that they have available to their most at-risk patients.  These disruptions may also discourage providers from wanting to participate in the H1N1 vaccination program, contributing to further delays in getting vaccine to individuals in the community.

DPH is as frustrated as you are about the current situation. Regrettably, neither the states nor the federal government have the ability to speed vaccine production.  What we can do is pledge to distribute the vaccine to the appropriate providers as soon as it becomes available and to keep providing the most up to date information on the situation.

Please remember that while we encourage all residents to utilize the comments section on this blog, DPH will no longer be able to respond to specific questions and comments.

Comments

[AJ]

I agree, target young adults (<24) with conditions BEFORE other young adults and before those 25-50 with conditions. My center says they've gotten to all 18yo with no conditions, but NO 19yo with multiple conditions. Ridiculous!

WRT distribution, each state sets its own policy whom to vaccinate. MA is following guidelines - good for us!! - some states are not. In some states people over 60 with no underlying conditions got H1N1 before young adults with issues!

[Susan Milliken]

Why is it that we're still scrambling to get the H1N1 vaccine to our most needy people in the suburbs of Boston and Boston, and whoever wants the vaccine at this point can get it in Tennesse? How do they figure the distribution population-wise?

[Katy]

I am 53, have asthma, COPD, lung cancer thats in remission and only one lung. I have been told by one of the major teaching hospitals in Boston that I am not high risk enough and not to expect a vacination until at least mid December. Everything I get goes to my one remaining lung. Some of my doctors have said that there is a good chance the Swine Flu will kill me if I catch it. I have worked very hard to beat this illness and am worried. I don't know what to do.

[Sharon]

This is an extremely frustrating and frightening problem for everyone; those at high or low risk. No one wants their loved ones to be effected - or die. Keep striving to get the vaccine, in the interim, please remember ....

This is a flu. And whether you have a cold, seasonal flu or H1N1 flu ... the treatments are mostly all the same.
Isolate yourself while you may be contagious.
Practice respiratory equiette (covering sneezes/coughs; frequent handwashing for everyone, hand sanitizing works well too.
Provide nutrition (whatever healthy foods they can eat/tolerate) and hydrate (Pedialyte, watered down juices - whatever your physician recommends).
Treat fevers.
As, as with any illness, watch for respiratory distress or other concerning symptoms ... No one knows yourself or child better than YOU. Seek treatment as necessary. Sometimes a conversation with your caregiver can provide the support or advice you need. Be seen as needed.

Calm and common sense goes far in these situations.

Vaccination is one part of the defense. Another important defense is good old HANDWASHING!!

Handwashing and respiratory equiette may be nearly as important as the vaccine. Have we taught our children well? Teach them the importance of not touching their eyes, nose and mouth. Wash, wash, wash.

You can't complain unless you've taken responsibility and control of what you can control.

Stay well.

[lorraine nava]

can my 6 month old get the swine flu vaccine?

[Lee Lewis]

My local health department (Beverly) is giving H1N1 vaccine now to pregnant women. They have not advertised this to the general public, but are working with the Birthing Center, and possibly with ObGyn offices. If you are a pregnant woman in Beverly but not a client of the Birthing Center or a local ObGyn office, you would not be aware that they have the vaccine. This seems wrong to me.

I'm not sure whether they're planning to vaccinate children. I was told yesterday that from this point on they will hold their vaccine supplies until they have enough to vaccinate the general public without running out. This effectively eliminates the CDC priority system. I'm in a high risk group because I have asthma, and will now need to wait to be vaccinated along with those who are not in high risk groups. I don't think this is what the CDC had in mind when it determined risk groups. I would appreciate the Mass. Dept. of Public Health reviewing this policy and communicating with local Health Depts. and Boards of Health -- Beverly in particular -- to make sure there is an understanding of why the CDC target group system is in place and how it should be put into action. Thank you.

[Alan Dove]

It's unfortunate that the DPH doesn't have someone responding to comments here, but their staff is likely focused on getting vaccines out. I'm a science journalist with a PhD in microbiology and some experience in disaster response, though, so I'll take a stab at a couple of the concerns voiced below.

First, pay attention to the numbers: 660,000 doses sounds like a lot, but that will only vaccinate about 10% of the state's population, so for all of you who are asking "where did all those doses go?" the answer is "into people who needed them." Just because you and/or your relatives haven't gotten the shot yet doesn't mean the state isn't trying.

Second, take a moment to think about the problem the vaccine makers are facing. They have a certain capacity to produce seasonal flu vaccine, but then they've suddenly been asked to produce a whole additional stockpile of H1N1 vaccine. Flu vaccine production requires growing the virus in eggs, which is a biological process that proceeds at its own pace. You can't make a baby in one month by impregnating nine women, and you can't double the capacity of flu vaccine production by snapping your fingers. Everybody wants this job done, and done right, but it's not easy.

I realize that we have a longstanding national tradition of trying to assign blame for everything, but there really are some problems that aren't anyone's fault. I'm quick to criticize incompetence when I see it, especially in emergencies. So far, though, the official response to this pandemic has been pretty good. That the response is inadequate is not the fault of the officials. Stuff happens.

Finally, I think we all need to get some perspective. Over 30,000 people die each year from seasonal influenza - about the same number as die on the nation's highways. This is tragic, but it's not a new problem. Nor is the emergence of a new flu strain surprising. Indeed, it happens all the time, which is why we need a new vaccine each year. The only difference is that this year, H1N1 showed up too late to be included in the regular seasonal vaccine. The current situation is certainly far from optimal, but it's hardly the end of the world. Let's just calm down, wait our turns, and get our shots when they're ready.

[BD]

A news report mentioned how a US firm extracts the HINI vaccine from just a single egg, and not 3-5 days as it takes in the labs overseas. The report also mentioned that it will not be until late January that the FDA could approve the US labs process. Why is this not the FDAs number one priority? We will on the downside of this thing(hopefully) by then.

[Patty]

Are you giving towns for recommendations for how to handle crowd control at clinics? You would be well served to get some advice from ticket sellers and other people who handle such events - especially given that nervous (pushy) parents and children will be involved. How about numbered wristbands that will allow the kids to play elsewhere while waiting?

Also, where are the 3-5 yo's supposed to get their shots? They aren't the highest-priority but they aren't eligible for the school clinics. Are pediatric offices being advised to turn away older students in favor of the younger kids?

How about advising pediatricians to use FaceBook pages to update their vaccination status? That would cut down on a lot of the phone calls.

Rather than holding off on the school clinics until all supplies are received, why not go by year? Start with the 5 year-olds because they are so touchy-feely and work your way up as supplies arrive. Or if it's the teens that are more vulnerable, start with them and work your way down. It just doesn't make sense to hold all the vaccines until the flu passes everybody by!

[MC]

I watched the news last night and saw that there was a clinic in Worcester for the H1N1 vaccine. There was a family that came from New Jersey to get vaccincated. First of all, I thought that the vaccines were going to health care workers, high risk children and pregnant women first. Then doesn't it make since to vaccinate children in school and in colleges(they will all be traveling home for Thanksgiving soon!) After all of these groups are taken care of , then clinics could begin. It doesn't seem like any guidelines are being followed. It's a little frustrating.

[John Murphy]

I'm told by our pediatrician not to even call until December 1st, as they don't expect any vaccine before then. Can this be right?

[Jill Scott]

In my community everyone ( and I mean EVERYONE) has already had H1N1. The entire community was like a ghost town for 2 weeks straight. Do we still need to get vaccinated? Why is there no vaccine for Strep? Its way more dangerous and just as contagious. My kids, and I only ran fevers for 2 days with H1N1, then we were fine.

[Liz]

There should also be a group for care givers of the immuno-compromised. I am a college student in the high risk category (I have asthma) who is a caregiver for my father (who is undergoing chemo and radiation treatment for cancer and is severely immuno-compromised) during my breaks. Even if I am fortunate enough to not get sick the longer I go without being able to get the vaccine the more likely it is I will be exposed and could potentially give this virus to my father, which can have devestating consequences.

[Jessica]

I am a pregnant woman who has been told that I have to wait for the vaccine? My OB/GYN office only received a limited supply last week, and when I called to get the vaccine, they put me off becaue I was not "high risk enough". The CDC website clearly states--as does this latest post--that pregnanat women are in the high risk category. If I can't get the vaccine from my own OB office, where can I get it? The main PHD website is not clear nor helpful with this information. Also, my husband is going to be a caregiving in the direct care of an infant, under 6 months old, as according to the CDC website, all fathers of newborns need to be vaccinated as well. The lack of organization and getting the vaccine to pregnant women--all pregnant women--is unexceptable.

[Dianne Z]

H1N1 vaccinations - Before you open up the under 25 category to all you should contemplate a window of time for the under 25 year olds with underlying health conditions. I have had no luck for our 15 yr old diabetic son who is in the high school atmosphere every day including the nurse's office for his diabetic care (sick students!!) AND on the football team which mixes up germs with every other player on his team and every other player on every team they play. We are in Central MA and there are a lot of sick people in this area.

[Jon]

Public School Teachers with direct student contact should be included as part of the prioritized group for the vaccine. Why aren't they?!? I am a teacher with asthma and have been unable to get the H1N1 vaccine.

My Boston Public High School does not have hand sanitizer, soap, and paper towels for kids or adults! Sick students drag themselves into school because they want to get "perfect attendance" or because their parents don't want them to stay at home alone!

[Incredibly Frustrated Parent]

FYI : It is Friday night 10/30. My teenagers (15 and 18)still cannot get h1n1 vaccine. When are they going to get it? With all due respect, I heard all week about about "more vaccine coming", but I do not see any appreciable improvement in the situation. 480,000 doses? Where?

[anne]

I have a 4 1/2 month old preemie and have tried to get on the vaccine from multiple areas but am told I am not a high risk as a pregnant mother. This contradicts what is stating in this update. Where do I go to get the vaccine since I am a caregiver of a infant less than 6 month who a preemie (the highest risk) and I am breast feeding????

[Kory]

I have heard repeated stories of people who are not high risk getting vaccinated for H1N1 while actual high risk patience are not getting it. What is DPH doing to assure that those most in need get it first. Can clinics/doctors be sanctioned if they do not abide by cdc guidlines. How is DPH monitoring the administration of these vaccines? I have been un successful in getting my young child vaccinated she is 22 months old. While I have a frind wo was able to get it for her 10 and 12 year olds. Not right, not right at all.-Angry and concerned father.

[Rob]

People might also be interested in knowing that the even the injectables are not interchangeable with respect to children, which I imagine complicates distribution even more. See:
http://www.cdc.gov/h1n1flu/pdf/monovalent_vaccine_dosage_chart.pdf

(Summary: Sanofi Pasteur's injectable is approved for 6mo and older. But Novartis's is only approved for 4y and older. And CSL's is only approved for 18y and older.)

[Rob]

THANK YOU for finally posting this (really -- it should have been posted weeks ago). This makes many things we've seen make more sense.

Also, of the 480,000 doses, how does that break down between FluMist and injectable?

And please post daily (or at least thrice-weekly) updates on the cumulative doses received and their FluMist/injectable breakdown.

[Donna Lewis]

why is it that health care providers(physical therapists for rehab) have already gotten the H1N1 vaccine(i thought over 25 was not as susceptible) but yet children/teenagersespecially those in school and college settings(i..e 5 to a dorm apartment) with severe asthma have not had a chance to get it. I also find it disconcerting that the regular flu shot is so hard to get for children. Many clinic do not vaccinate children and the pediatricians never seem to have it. This is coming from a parent who has already lost 1 child to the flu years ago and do not want to see this happen to anyone again!!!!