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Introduction
H1N1 is the source of numerous health care controversies. This is particularly the case of vaccination and vaccine allocation, since vaccine shortages may cause long-term effects on public health and increase the risks of H1N1 pandemics. It goes without saying that today’s legal mechanisms of vaccine allocation are far from perfect. Health care officials must be particularly creative in the development of vaccine allocation strategies. Declaring a Public Health emergency may aid health care organizations in achieving the highest penetration of influenza vaccines into the greatest number of high-risk persons. The Department of Health may also allow the existing private sector distribution methods to address the pandemic influenza vaccination needs of the community. Neither of the proposed solutions is entirely satisfactory. Yet, in the absence of viable legal mechanisms of vaccine allocation, declaring a Public Health emergency can give the Department of Health a strong advantage in its fight against the risks of H1N1 pandemics.
H1N1 Flu: A Brief Background
H1N1 has become a distinctive feature of the global health reality. H1N1 no longer frightens anyone, although its effects on public health are profound and multifaceted. Also called “swine flu”, H1N1 is a relatively new type of influenza, first detected in 2009 in the United States (Ohio Health). The virus spreads like other types of influenza, from person to person (Ohio Health). Severe illness is uncommon, although possible (Ohio Health). That individuals with H1N1 can infect others up to 7 days after getting sick is the most threatening factor of the disease (Ohio Health). Statistically, younger individuals are more susceptible to the risks of H1N1 than older populations (Louie et al 1896). 40% of all H1N1 cases occur in adolescents (Louie et al 1986). Almost all individuals younger than 50 years are at risk for H1N1 (Louie et al 1896). The main risk factors for H1N1 complications include immunosuppression, lung disease, and pregnancy (Louie et al 1986). These high-risk populations demand particular medical attention. Vaccination can give them a chance to avoid the infection or at least reduce the risks of H1N1 complications. H1N1 vaccines must target pregnant women, individuals with lung disease and immunosuppression, as well as those younger than 18 years old.
H1N1: Devising a vaccination strategy
Today’s mechanisms of vaccine allocation are imperfect. At times of emergency and vaccine shortages, all health care policies and department decisions must aim at (1) assessing the local supply of vaccine; (2) assessing the number of high-risk members of the community and assessing the demand for vaccines; and (3) “ensuring that to the greatest extent, the limited local supply of vaccine is used exclusively by those at highest risk within the local jurisdiction” (Iton 350). This is possible by either declaring a Public Health emergency or giving health care providers a carte blanche in dealing with the risks of influenza epidemics. Both strategies have serious advantages and visible drawbacks.
Declaring a Public Health emergency can give the Department of Health a serious advantage in dealing with vaccine shortages and the risks of influenza pandemics. First, it is under conditions of emergency that the Department of Health can quickly assess the state of vaccine supply through public and private entities. The fact is that, under normal conditions, private and public suppliers and health care institutions may be reluctant to release information regarding vaccine supply (Iton 353). Trade secret concerns, business competition, and the fear of legal liability for holding inadequate supplies of influenza vaccine can explain health care facilities’ reluctance to publicize these data (Iton 353). In conditions of a Public Health emergency, the Health Commissioner can obligate influenza vaccine providers to respond to official vaccine supply inquiries. The Health Commissioner can also issue an administrative subpoena, to obtain legitimate access to vaccine shipping information and validate inventory information concerning vaccine supplies (Iton 353). Second, a Public Health emergency can let the Health Commissioner audit and monitor the process of vaccine allocation, to ensure that limited supplies target high-priority populations. The Health Commissioner will be able to demand that limited supplies of vaccine be commandeered from private and public providers and penetrate into high priority populations (Iton 354). Under normal public health conditions none of these actions is possible. Only a Public Health emergency can legitimize the health commissioner’s authority to commandeer vaccine supplies from private health care entities and providers (Iton 354).
Notwithstanding the benefits of a Public Emergency, the mere word “emergency” can generate panic and anxiety among state residents. Panic and anxiety are extremely undesirable, given the effects they may cause on public health and wellbeing. Alternatively, the Health Commissioner can allow the existing private sector companies and providers to address the pandemic influenza vaccination needs. As always, the need for engaging private health care players in vaccination planning and pandemic response efforts is critical (Smith & Strikas 305). The U.S. Department of Health and Human Services has developed a number of strategies to facilitate collaboration and partnerships between local private and public vaccine providers (Smith & Strikas 305). Private entities may add to the vaccine supply from public providers. However, under normal conditions, such partnerships can do little to deal with the problem of vaccination shortage. This is because the 1938 Food, Drug, and Cosmetic Act prohibits any movement and reallocation of drugs between hospitals and providers, unless initiated for emergency reasons (Hodge & O’Connell 345). Therefore, private sector organizations alone cannot enhance the supply of influenza vaccines and their allocation among high-risk populations.
Objectively, neither of the two alternatives is entirely satisfactory. Panic about the state of emergency is highly undesirable. Yet, under normal conditions, private and public entities may refuse to disclose information regarding vaccine supplies. Moreover, the movement and reallocation of drugs and vaccines under normal public health conditions are strictly prohibited. Another problem is that neither of the two solutions increases public awareness of influenza and informs the public about the importance of H1N1 vaccination. In the meantime, whether or not the public accepts and adheres to public health measures recommended by the Department of Health directly depends upon the way the general population perceives the risks of getting infected (Seale et al 104). Low awareness means low anxiety about the risks of influenza; the latter, in turn, predicts little to no change in behaviors against the background of the influenza pandemic (Seale et al 104). Public awareness of influenza risks is what the Department of Health needs, to expand vaccination coverage and ensure that the risks of infection in high-priority populations are minimized. Partnerships created during vaccine shortage seasons can benefit public health before and after influenza pandemics (Smith & Strikas 305). As the pandemic is getting closer and the shortage of vaccines threatens lives and wellbeing of all community members, only declaring a Public Health emergency can give the Health Commissioner a strong advantage in allocating scarce vaccination resources among all populations at risk for influenza.
In the absence of viable legal mechanisms of vaccine allocation, declaring a Public Health emergency is the best way to deal with vaccine shortages. The state is running of time, and there is no other chance to deal with broad policy challenges affecting the vaccine market. Everything should be done here and now. Only a Public Health emergency can give the Health Commissioner the right to assess the supply of vaccines and reallocate available vaccine supplies in ways that target at-risk populations. These emergency efforts must be coupled with broad public awareness campaigns, to communicate the meaning and relevance of the emergency and increase the population’s vaccination coverage. Under normal conditions, the Department of Health must develop and sustain effective partnerships with private healthcare entities. These partnerships will eventually help to raise public awareness of influenza risks and guarantee that all health care providers, irrespective of their form, have sufficient vaccine supplies in case of an emergency.
Conclusion
In the absence of viable legal mechanisms of vaccine allocation, declaring a Public Health emergency can give the Department of Health a strong advantage in its fight against the risks of H1N1 pandemics. It is under conditions of emergency that the Department of Health can quickly assess the state of vaccine supply through public and private entities. Only a Public Health emergency can legitimize the health commissioner’s authority to commandeer vaccine supplies from private health care entities and providers. Certainly, this alternative is not entirely satisfactory. The public lacks awareness of H1N1 risks. A Public Health emergency coupled with broad public awareness campaigns can give the Health Commissioner the right to assess the supply of vaccines and reallocate available vaccine supplies in ways that target at-risk populations.
Works Cited
Hodge, James G. & Jessica P. O’Connell. “The Legal Environment Underlying Influenza Vaccine Allocation and Distribution Strategies.” Journal of Public Health Management and Practice, 12.4 (2006): 340-48. Print.
Iton, Anthony B. “Rationing Influenza Vaccine: Legal Strategies and Considerations for Local Health Officials.” Journal of Public Health Management and Practice, 12.4 (2006): 349-55. Print.
Louie, Janice K. et al. “Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California.” Journal of American Medical Association, 302.17 (2009): 1896-1902. Print.
Ohio Health. “General H1N1 Information.” Ohio Health, 2011. Web.
Seale, Holly, Anita A. Heywood, Mary-Louise McLaws, Kirsten F. Ward, Chris P. Lowbridge, Debbie Van and C. Raina MacIntyre. “Why Do I Need It? I Am Not at Risk! Public Perceptions Towards the Pandemic (H1N1) 2009 Vaccine.” BMC Infectious Diseases, 10 (2010): 99-107. Print.
Smith, Nicole & Raymond A. Strikas. “Approaches for Improving Influenza Prevention and Control.” Journal of Public Health Management and Practice, 12.4 (2006): 303-7. Print.
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