|What hasn't worked well:
1.Vaccine supply of course. This has been a tremendous burden and headache. Over the years we've always planned to have the vaccine in huge quantities so we could administer via points of distribution (PODs). For us to establish a POD and only have a few hundred doses is not worth the time and the costs. Due to the likelihood that we'll see small amounts of vaccine over the winter months we are changing our strategy to include smaller "express clinics" at the Health Department most days of the week, getting vaccine out to pharmacies, working with partners such as VNA and Ronald McDonald van. Basically our strategy is to have as many access points as possible for the public.
2.The number of local physicians who agreed to provide H1N1 vaccination. We were a bit disappointed but in talking to the practice managers the reasons for not providing the vaccine included: workforce issues--physicians felt they would be slammed by the numbers of people ill and didn't feel they had enough staff to provide vaccinations as well; safety issues for their staff--in 2003 when seasonal flu was in short supply some office staff members were physically abused and police had to be called. In one instance a person lost sight in their eye after a pencil or pen was thrown when the person was told they were out of vaccine. News like that gets around the medical practices rather quickly and there is/was a fear that this may happen again.
3.Sites for PODs. When we planned our PODs in our pandemic flu plan we made the assumption that schools would be closed in a pandemic situation so using the school facility would be perfect. Since schools are open, access to them has been difficult. We have 15 different school districts with dozens and dozens of school buildings so providing school based clinics was impossible for us.
4.Public health staffing is an issue. Our health department has lost 70 FTE since 2000. While we can hire additional help you still need people who know public health to be in leadership positions and oversee the temporary help.
5.We had to close our Immunization and International Travel Clinic program so the 4 nurses and program assistants could develop and implement the vaccine tracking/control activities. Since so many local physicians only wanted vaccine for their staff and needed less than 100 doses we find this takes a fair amount of time to repackage and prepare for pickup. Plus this is the same group who assures vaccine arrived at the various points in the county as we thought we've had issues with vaccine not arriving and having to back track. The fact that there is not a tracking number has made it difficult to find out if the package got delivered somewhere else, didn't come at all, or what is going on.
6.Some parents are losing it with trying to get vaccine for their children with underlying medical conditions. While we're doing our best to get vaccine out to as many providers as we have vaccine there are parents who fall through the cracks. We've been threatened with law suits and many other things. Plus the public is not happy that we've had to cancel many routine public health services or can't do as many so they have verbally abused staff as well.
7.Key staff are running out of steam already. They are tired! While we have backups for all key positions, in a local health department you just have people who really know what's going on in their areas and there are conference calls and meetings all day, every day of the week just trying to stay updated on the changing situation, let alone getting the work done.
8.We've probably had to reduce routine public health services by 25% overall and in some areas (where we have nurses) 50% to 100%. This will affect us when contacts/grants come due and we haven't met all our deliverables. Many of our contracts are caseload based and if caseload goes down so does the money in the next contract. While I believe this has been discussed at federal and state levels I'm not seeing anything that makes me feel that our work on H1N1 won't have a negative effect on our funding for the upcoming year. While everyone states "We know you're so busy," they still want the same levels of information/reporting/services.