Whom to vaccinate and when has been a very challenging aspect of responding to the novel H1N1 pandemic.
The Virginia Department of Health (VDH) determined early on that people would not be turned away if they wanted to be vaccinated, regardless of priority groups.
The primary reasons were to avoid creating an adversarial relationship between public health and residents, and to protect people's privacy, said Diane Helentjaris, MD, MPH, Deputy Director of Epidemiology for VDH.
"Sometimes people do not want to share. They may have never been to a health department and they don't want to share private information as to why or why not they are in a priority group," she said. "Say they have HIV/AIDS. They shouldn't have to disclose that."
Virginia took extensive steps to emphasize the vaccine priority groups recommended by the Advisory Committee on Immunization Practices (ACIP). Communication before and during mass vaccination clinics would explain who should be getting vaccine that day and who should wait to receive it later. Clinics also had workers who traveled up and down the waiting lines of people to explain who should get the shots and who should wait.
"Some people would just leave the line and say they would get the shot later," Helentjaris said. "Other people stayed in line, and they got their shot."
This was a quiet policy. "Our approach was not to advertise it at all, but if people showed up, to give it to them," she said. "When you went into the schools to vaccinate the kids, if there's a teacher there and they ask for a shot (providers were told) to give them a shot."
Sometimes people would say they were at a school clinic and saw people get shots who were not in priority groups, she said. "Our response back was: You just don't know. They could be an older person who cares for a child less than 6 months old."