H1N1 Virus Puts Public Health Agencies On Alert

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President Obama has declared a national state of emergency because of the H1N1 virus, or swine flu. A nationwide shortage of the vaccine is forcing public health departments to focus on the highest risk groups. Saturday, at some 40 clinics throughout Maricopa County, Ariz., the vaccine was given to pregnant women and young children. Dr. Bob England, of the Maricopa County Public Health Department, explains his region's plans to combat the virus.

MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, the president has declared the H1N1 virus a national emergency that frees up hospitals to screen and treat patients if need be in outdoor tents. We'll talk to a doctor in one Tennessee hospital doing just and we'll talk about what other steps his hospital is taking to cope.

But first, nationwide the shortage of vaccines to combat the H1N1 virus is causing anxiety and forcing public health departments to focus on the very highest risk groups. This Saturday at some 40 clinics throughout Maricopa County, Arizona, the decision was made to give the vaccine to pregnant women and young children. The effort followed educational outreach efforts in English and Spanish.

To hear how it all went, we decided to call Dr. Bob England, director of the Maricopa County Public Health Department. He joins us from his home office in Phoenix, Arizona. Welcome, doctor. Thank you for joining us.

Dr. BOB ENGLAND (Director, Maricopa County Public Health Department, Arizona): Hey, thank you for having me on.

MARTIN: And I just want to mention, I don't have the flu. This is just a cold, I apologize for my voice...

(Soundbite of laughter)

MARTIN: ...but I'm not in here infecting people, I just want to assure you of that.

Dr. ENGLAND: Okay.

MARTIN: Okay.

Dr. ENGLAND: Okay, if you're sick, stay home, you know.

MARTIN: Yes, sir, that's what I've been told. So, can I just ask, how much vaccine would you like to have? And how much do you have? In essence, how bad is this shortfall?

Dr. ENGLAND: You know, it's been coming out frustratingly slowly. We've been getting enough for a little more than one percent of our population per week. And having built up the demand for this ahead of time and having done the job that we needed to do in terms of education about this, it's been really frustrating then to step back and have to target your vaccine so narrowly just to those who need it most.

So, right from the beginning we've been adhering to two principles. One is to push it to those who need it most, and just as you said, young children, children with underlying health conditions and pregnant women primarily.

MARTIN: Some places are focussing on health workers.

Dr. ENGLAND: Our very first shipment went to health care workers in hospitals. We did that because we're all going to rely on them as you'll hear from your next guest. They're the backbone of what we need to do. The second principle we've been adhering to is to move it as fast as possible, because right now we're in a flat out race between the spread of the disease and how fast we can protect people. And, you know, we don't want any sitting around in a refrigerator when it can be used by somebody who needs it.

MARTIN: How did the clinics go? And did you get the kind of response that you had hoped for? There was also a clinic, for example, in the area where I live in the Washington, D.C. area over the weekend and there were wildly varying responses just in this one region. There were some people who, you know, stood online, went in, you know, made sure that they made themselves available at the first opportunity. In other places, people were still skeptical saying, you know, I'm not sure I need this. I don't know that I need to do this. So what kind of response did you get?

Dr. ENGLAND: Yeah, that's the phenomenon with flu shots. It's perplexing to me, why the uptake is so varied between people. But I'll tell you, we did it at 40 different locations because we didn't want long meandering lines. We didn't want some of those nightmare scenes you see of people who stand in line for hours and hours. We gave about 17,000 doses of vaccine at all the different sites on Saturday, which I understand so far at least I'm told is the largest one-day effort. We did it this way - you know, from the beginning, we've been doing it through the private sector. And as we got our first doses of vaccine trickling in, we sent it to pediatricians and obstetricians as well as the health care community, as you mentioned, to give the highest risk folks right away.

And we always planned shortly thereafter to have a lot of other locations available where people could get vaccinated because not ever doc participated and an awful lot of people don't have docs. So, we needed something for all those many people who weren't getting it from private providers. What happened for this one-day clinic is we literally realized on Thursday afternoon that a shipment that we had slated for our first round of school-based clinics came in a little bit early. We had it on hand. We didn't want it sitting around for a week waiting for those schools, so we asked the provider, we already given it to essentially give it back and operate all these sites between us and several private providers.

MARTIN: Finally, I wanted to ask, it's a sensitive question, but here in Maricopa County in Arizona. In a way, it's ground zero for a lot of the debates that we have over immigration...

Dr. ENGLAND: Yes.

MARTIN: ...and service delivery to people of different immigration statuses and so forth, and I wanted to ask, are people able to get vaccine regardless of their status - of their immigration status? And are people who are - do you feel that your efforts to sort of mass vaccinate, particularly vulnerable population were complicated by some of the enforcement efforts that we hear so much about - that has nothing to do with health overall but that are very much a part of the news?

Dr. ENGLAND: Yeah, you know, the germs don't care how you got here. They care that you're here and that they can jump from you to somebody else, to somebody else, to somebody else. You know, the way vaccines work, in general - the reason that all those formerly common childhood diseases are gone, or for most of us essentially gone is by something called the herd effect. It's not your vaccine that protects you as much as it is the fact that everybody around you got vaccinated so that you don't get exposed to the germ anymore. It's hard for the virus, in this case, to find the next person to infect, and then the next person, and then the next person, and ultimately you.

I think it's kind of cool, actually nothing screams so loudly that we're all in this together than the fact that being vaccinated helps to protect your neighbors and that most of your protection comes from your neighbors being vaccinated. So, of course, we vaccinate anybody who's here. And we've done a lot of work in the Spanish speaking community, documented or not, to come in and get vaccinated for this. Want to work upfront with the Spanish media with community based organizations even with Mexican and Guatemalan consulates and so forth to make sure that people felt comfortable...

MARTIN: Okay...

Dr. ENGLAND: ...coming in.

MARTIN: All right, we have to leave it there for now. That was Dr. Bob England. He's director of public health for Maricopa County. And he joined us from his home office in Phoenix, Arizona. Dr. England, thank you.

Dr. ENGLAND: Thank you.

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