Flu season is upon us. But every time I hear that simple question or a request for the latest H1N1 update, I am dismayed that we don’t have a robust system for distributing vaccines.
Our university hospital debated mandating flu vaccination for health care professionals—a sensible approach, given that we care for some of Cincinnati’s sickest and most complicated patients. There was just one hitch: We don’t have an adequate supply of vaccine. Sure, we ordered enough, but like many health systems and providers, we received only about half of what we need (the result of a production problem, we were told). We suggested that our CEO call Kroger, a Cincinnati-based food chain, to see if we could share its supply of flu vaccine.
Accessing H1N1 vaccine involves a Byzantine process that we have yet to figure out. Call the Health Department? See if CVS has it? Acquire a secret decoder ring?
How hard is it to distribute a commodity to the places with the greatest need? Pretty difficult, it would seem. The initial distribution of antivirals ran afoul because no one thought about storage requirements. And, for some unexplained reason, major store chains like Kroger, Walgreens, and CVS all received sufficient quantities; health systems and doctors’ offices did not.
State health departments are supposed to solve such problems, but many offer little help—promoting parallel immunization clinics, in some cases, rather than redirecting immunization supplies to patient-centered medical homes. Inadequate reimbursement, multiple registries, and complex guidelines make matters worse.
Here is my simple solution:
- Offer manufacturers incentives to produce an adequate supply of vaccine.
- Centralize distribution, and supply vaccine to health care facilities and providers first—before retailers.
- Require that every insurer cover CDC-recommended vaccination at 10% above cost.
- Integrate vaccination registries into the major electronic health record systemS, and assure transfer of immunization information from every outside point of care to the primary care medical home.
My final suggestion? Recommend that everyone be vaccinated. Maybe next year I’ll be able to tell my patients, “Of course, you can have that flu shot today!”