MELISSA BLOCK, host:
For some people, searching for the swine flu vaccine has meant repeated calls to a doctor's office. For others, it's meant standing in line at a school or a mall. People around the country have had a hard time getting access to the vaccine.
As Sarah Varney of member station KQED reports, it all depends on where you live.
SARAH VARNEY: As you leave San Francisco and drive east over the Bay Bridge, the dense urban neighborhoods give way to suburban sprawl and oversized shopping malls. The million people who live here in Contra Costa County are spread out over endless rolling hills. Unlike the city, residents here drive everywhere and shopping malls are the center of public life.
Dr. WENDEL BRUNNER (Public Health Director, Contra Costa County): We've been planning on major flu clinics in shopping malls, which is a good location in our county.
VARNEY: The county's public health director, Dr. Wendel Brunner, is standing in a vast JCPenney parking lot. It's 10 a.m. on a recent Saturday morning and thousands of people are waiting in line to get vaccinated. The county has a limited amount of H1N1 vaccine right now, and Dr. Brunner says only young children, pregnant women and caretakers of infants will be immunized today.
Dr. BRUNNER: We want to make sure those people are immunized first. And as more vaccine comes in, then we'll broaden the categories.
(Soundbite of crowd)
Mr. CLIFF CROCKSVILLE(ph): Im going to sit you down. We got to take your arm out.
Ms. CARRIE CROCKSVILLE(ph): You want a chair for him?
Mr. CROCKSVILLE: Ill just do it here. He probably won't (unintelligible). Okay, stick your left arm out.
Ms. CROCKSVILLE: We need your arm.
Mr. CROCKSVILLE: Thats a big boy.
Ms. CROCKSVILLE: Good job, buddy. Perfect.
Mr. CROCKSVILLE: There you go.
VARNEY: Under a glistening white tent, three-year-old Matthew Crocksville(ph) burrows into his father's chest as if he could somehow escape the inevitable.
Mr. CROCKSVILLE: Itll be real quick and we'll be all done.
Ms. CROCKSVILLE: Yeah.
VARNEY: It's over in an instant, and Cliff and Carrie Crocksville give their son Matthew reassuring kisses. Since their pediatrician didnt have the vaccine, they decided to come here.
Mr. CROCKSVILLE: It seems like it's sporadic. So, you hear people about, oh, it was real easy and then you hear other people struggling. You hear a lot of horror stories about long lines, so, pleasantly surprised this morning.
VARNEY: The confusion over why the supply of H1N1 vaccine comes and goes is common. And still, others can't make sense of why it's available at some pediatricians' offices, and yet in the county over, you can only get it at hospitals, schools or mass vaccinations, like the one here today.
These different approaches reflect the strong preference for local control, says Dr. Paul Jarris of the Association of State and Territorial Health Officers.
Dr. PAUL JARRIS (Executive Director, Association of State and Territorial Health Officers): The unifying theme there is it's a matter of getting the precious vaccine to the people at highest risk. How that is done really depends on everyone's community.
VARNEY: Some counties are more rural or urban, others have higher rates of uninsured. For example, here in California, in Imperial County just east of San Diego, some 30 percent of the population is uninsured. So, relying solely on private providers wouldnt work.
But in Sacramento County, where many residents are state employees with good health insurance, county health officials have delivered the vaccines almost exclusively to private providers and aren't planning any public vaccinations until later in the month.
Dr. JEFF LEVI (Executive Director, Trust for America's Health): It wouldve been a disaster if we had stuck to the seasonal flu approach of vaccine distribution.
VARNEY: Jeff Levi, executive director of Trust for America's Health, says with seasonal flu vaccine, health providers order directly from the manufacturers. But with H1N1, the Centers for Disease Control is distributing it to state health departments.
Dr. LEVI: That assures us that every jurisdiction will get their share of what is available regardless of how an individual company may be doing in terms of its production capacity. That made for a much more equitable distribution system than we wouldve seen had we relied on the traditional seasonal flu process.
VARNEY: There had been anecdotal stories of people who are not at high risk getting access to the H1N1 vaccine. But, by and large, those seem to be more the exception than the rule. For public health departments around the country, the H1N1 vaccination effort comes at a time when their budgets had been slashed and large numbers of workers laid off.
Dr. Jarris represents state health officers.
Dr. JARRIS: You can't starve a system and then expect magically it's going to turn on. It's almost as if we all shuttered our fire departments, you know, turned off the plumbing and stopped fixing the roof, and when there is a fire, we say, where is the fire department?
VARNEY: Whatever their budget problems, local public health departments will have to find a way to sustain their efforts for several more months.
A spokesman for the CDC says because of production delays, it's likely many Americans including those in the high-risk groups won't be able to get the vaccine until early next year. And though the CDC can't say for certain how long the H1N1 flu season will last, they expect the virus could stick around until next spring.
For NPR News, Im Sarah Varney.
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