Waiting for the Vaccine: An H1N1 Emergency

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Frank Polich / Reuters

Some 1,200 people brave rain and 39°F temperatures to receive a free H1N1 flu vaccine at Richard J. Daley College in Chicago

Shortly before 9 a.m. last Saturday, more than 400 people waited in line outside the Balboa Sports Complex in Encino, Calif., anxious to enter one of several Los Angeles County Public Health clinics offering free H1N1 vaccines to those considered high-risk. The first person in line had arrived at midnight, while many others had assembled well before dawn to ensure they would get the vaccine when the clinic doors opened at 9. Over the next several weeks, the county will distribute the 300,000 doses of H1N1 vaccine it received out of the 1.3 million doses sent to California by the Centers for Disease Control and Prevention (CDC). However, Dr. Jonathan Fielding, director of public health and health officer for Los Angeles County, says the county will need at least 5.5 million doses to cover those in high-risk categories for flu-related complications.

As flu season wears on, public demand for the H1N1 vaccine — and annoyance with its lack of availability — is likely to continue until supplies catch up to the need. President Barack Obama's declaration of swine flu as a national emergency has only added to the clamor, inspiring folks who were on the fence to get vaccinated. "I wasn't really concerned until Obama made the announcement. It put me on alert and got the ball rolling," said Adia Armstrong, 28, who took her two young sons to the Encino clinic to get vaccinated. "Kids are dying and I need to protect my kids."

Originally the clinic was intended for those without health insurance or access to regular medical care, but Los Angeles County was allowing anyone in high-risk categories defined by the CDC to get the vaccine. This group included pregnant women, health-care and emergency-services personnel, those living or caring for infants under six months of age and people aged 25 to 64 with health conditions that put them at higher risk for flu-related complications.

Like many in line, I had gone out of growing frustration at not being able to get the vaccine through other, private sources. I am four months pregnant and have asthma. My medical providers had highly urged it but didn't have the vaccine and could not say when they would receive their supply. Private hospitals and clinics I called directed me back to my doctors and so the fruitless search continued. A few hours' wait in 90°F heat seemed like a sacrifice worth making. Bryan Song and his wife Alice had been in line since 6:30 a.m. with their 13-month-old son Payton. "He's in day care and there have already been three cases of H1N1 reported there. We're here more for him," said Alice.

I finally got the shot. I was pulled into a shorter priority line for those who were pregnant or with severe health conditions and received one of only 60 doses of the thimerosal-free vaccine recommended for pregnant women. About half an hour after I got my shot, they ran out of this version of the vaccine. The whole process took almost two hours.

Flu activity, virtually all of it of the swine-flu variety, is now widespread in 46 states and at a level equal to the peak of a typical winter flu season, according to federal officials. Unlike the seasonal variety, which tends to be most harmful to those over 65 years old, swine flu skews far younger, which explains the large number of parents with children still dressed in their pajamas who waited hours outside the Encino clinic before the sun rose to get the vaccine. (The CDC found that more than half of the hospitalizations from 2009 H1N1 flu reported by 27 states between Sept. 1 and Oct. 10 were people aged 24 and younger. About 23% of the deaths reported from 28 states during this period were in this age group.)

Thousands of people across the country did likewise last week, as county health clinics began distributing their first shipments of the coveted vaccine for free to at-risk groups. However, because of production delays, supplies of the vaccine have been far lower than requested, forcing some counties to severely curtail their original plans.

In Macon County, Ill., the County Health Department has been forced to limit their first doses of the vaccine to health-care workers and emergency-services personnel and children ages 4 to 18. Out of the 70,000 doses the county requested, they only received 5,400. "Since we got such a short supply right now we wanted to give [the vaccine to] the group that has been most affected, and because this is a vaccine that can be used for children, we wanted to make sure and get the vaccine to the children while we could," says Brandi Binkley, director of Health Promotion for the Macon County Health Department in Decatur, Ill. "Since October 1, we've had 24 people who were hospitalized and lab-confirmed H1N1 and five of those were this week, seven were last week. And our median age is 9 years old here."

Officials at some of the initial H1N1 clinics offered in Polk County, Iowa, this month were deluged by public demand. The county ultimately expects to receive 273,000 doses of the H1NI vaccine, but had to make do with 6,000 out of the 8,400 doses allocated in the initial shipment. "We were overwhelmed," Rick Kozin, spokesperson for the department says. "During both of the last two clinics we ran out of vaccines before we could treat all the people who were in line. People were frustrated, as were we, and disappointed that they were going to have to come back to get the vaccine." In response, the department further limited who could receive the vaccine at the clinic they held on Sunday.

Some states like Massachusetts have been forced to postpone flu clinics for the general population altogether, given production delays for both the seasonal and H1N1 vaccines. "We have heard from various parts of the country, from clinicians to other folks who are part of being providers of the vaccine, that they have not received their supply that's been ordered, unfortunately," says Llelwyn Grant, spokesperson for the CDC. "We recognize we're behind the curve in getting out the amount of doses to support many of the clinics and other facilities that are set up for the vaccine, but we still have time and we're working steadily with some manufacturers to increase those numbers."