United States: Helping Massachusetts get H1N1 Vaccine to its Citizens

Facing the threat of a swine-flu pandemic last summer, the Massachusetts Department of Public Health (DPH) prepared to design and implement a system for vaccinating the state's citizens most at risk. Time was of the essence.

In public-health parlance the DPH had to ramp up to "surge capacity" in a few scant weeks. Word reached the DPH in August 2009 that the first shipments of the H1N1 influenza vaccine would arrive in Massachusetts by mid October. Other shipments were to follow in quick succession.

In Massachusetts, unlike many other states, there was no network of county health departments to oversee the distribution and administration of the vaccine but, rather, the DPW collaborates with 350 local boards of health. In partnership with the local boards, the DPW had to act quickly to ramp up a system for registering, prioritizing and monitoring thousands of hospitals, community health centers, doctors' offices and other prospective vaccination sites throughout Massachusetts.

As its technical-assistance partner in the ramp-up, the DPH retained JSI Research and Training Institute, a health consulting company based in Boston. Within two weeks, starting on August 27, JSI had a staff of eight people trained and working in concert with DPH personnel on the vaccination program.

"The challenge was to understand quickly the broad issue of influenza, as well as the specific demands of the H1N1 vaccine, and then jump onboard to help design and explain the distribution system in a climate of anticipation and anxiety," says Stewart Landers, the senior JSI consultant on the project.

A first step was establishing an online registration process, which in effect amounted to a census to identify the number of high-risk patients within the populations served by each vaccination site. The high-risk group that was to be vaccinated first comprised health-care workers, pregnant women, children and young adults under the age of 24 and older adults who were particularly vulnerable to the H1N1 virus because of some underlying medical condition.

The vaccine allocation for Massachusetts by the Centers for Disease Control and Prevention (CDC), the federal agency in charge, totaled 3.3 million doses. That meant that close to half of the state's 6.4 million people were to be vaccinated over the autumn and winter months.

With the Web-based system swiftly in place, the DPH was able to register 4,481 sites. One complication: up to five percent of the sites, including small pediatric practices did not meet the CDC's 100-dose shipping requirement. But the registration protocol enabled the DPH to designate some large sites as "depots," from which vaccine was relayed to smaller sites.

Vaccine shipments to the Massachusetts sites have been arriving at the rate of three or four a week. To monitor the shipments, the JSI "help desk" team, has been deployed at the Hinton State Laboratory Institute. Where there have been shortfalls or surpluses, the help desk has redistributed the vaccine and operated as a clearinghouse for information.

The JSI staff members involved in the project were also available to provide background research and logistical expertise. For example, JSI worked closely on such matters with the Massachusetts Office of Pharmacy Services, which managed distribution of the vaccine to public hospitals, mental health facilities, county jails and houses of corrections.

A priority right along was ensuring that the people most at risk were vaccinated first, a goal that Landers says the DPW achieved. He says: "We feel the public-health officials, with whom we worked, did an excellent job so that those at highest risk really did get the vaccine first."

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