Local Health and H1N1

1. Local Health and H1N1 Anne Bailowitz, MD, MPH Medical Director, Environmental Health and Emergency Programs Bureau Chief, Child Health and Immunization Baltimore City Health Department NVAC Teleconference July 27, 2009

2. Local Health and H1N1: Issue 1 - Staffing • Work of public health continues, H1N1 persists: ensuring clean food/water; • freedom from “other” infections; response to “other” emergencies • Local health (LHDs): major cuts in staffing and budgets • - 2008: 27% of LHDs had budget cuts; 53% had layoffs • - 2009: 44% of LHDs had budget cuts; 32% had layoffs • Where is the clinical and clerical staff to give H1N1 vaccinations, answer • telephones, and do the daily work of public health? • Initial stimulus originally favored vaccine over operating costs: 75%/25% in MD

3. Issue 1 - Staffing Options Extend short staffing through partners: - Private practice pediatricians, family practitioners, internists, OB GYNs extend the reach of LHDs - Hospitals can immunize their own staff; partner with LHDs for community communication and immunization - Pharmacists - Local agencies e.g. fire department EMTs - School and day care center sites - Immunization Action Coalition - For profit mass immunizers Partner choice depends on target population: - Multiple partners for children: private physicians, public health clinics, school-based Cross train staff Use volunteers: schools of nursing, medicine, colleges, etc Outsource non-essential tasks Maintain staff morale Remember costs: know vaccination insurance coverage, administration fees

4. Local Health and H1N1: Issue 2 – Vaccine Availability • H1N1 vaccine may not be available until later in the autumn, after the arrival of seasonal vaccine • Shipments may be numerous • Questions: vaccine allocation • distribution • priority groups • expected role of LHDs • - LHDs lacking infrastructure for a mass vaccination • campaign

5. Issue 2: Vaccine Availability Options LHDs lack significant input re:licensure, manufacturing capacities, and delivery plans NACCHO has successfully advocated for LHD participation in planning The emphasis is on planning for different possibilities Partner with local logistical experts: - Supply officers from the Armed Forces / National Guard - Logistical and supply managers of hospitals - Construction company executives - Major retailers

6. Local Health and H1N1: Issue 3 - Logistical and Administrative Demands • Concurrent mass vax programs + vaccine delivery dates = complex • plans for staffing, vaccine management, clinic scheduling • Adverse events reporting – imperative but time consuming • Drop-shipping vaccine, unlike SNS handling of anti-virals, imperils the • cold chain key to vaccine potency • Number of doses: up to four possible, reminder recalls, etc. • Baltimore (and others) want to try school-based clinics, but that strategy • will require additional administrative time to plan and implement • Will we be mass distributing anti-virals at the same time?

7. Issue 3 - Logistical and Administrative Demands Options Partnerships are still key to success Tailor partners to target populations e.g. OB GYNs, nurse midwives for pregnant women Role for MDs, hospitals, practice groups for children, adults, health care workers Business sector: large firms immunize their own employees e.g. Fidelity in Nashua, NH area Volunteers for clinics: scouts; high school (health care tracks e.g. Dunbar HS in Baltimore) and college students; athletic teams; nurse sororities; elder service groups; community social, business, faith and service groups Other shot-givers: student nurses; medical school students; dental students; dentists; veterinarians; medical reserve corps; private-for-profit vaccinators; pharmacy chains Talk to potential partners NOW

8. Local Health and H1N1 Vaccine: Issue 4 - Communication • Basic messages for the public: • - Define seasonal vs H1N1 vaccine • - Who needs both vaccines and how many doses • - Emphasize minimal/no protection of seasonal vaccine against H1N1 • Messages will impact clinic screening and staffing + LHD phone management • Surge capacity needed for media, public and clinician calls • Technical messages e.g. case definition/ lab testing - complex definitions, rapid • change • Media coordination with States and CDC will be of utmost importance

9. Issue 4 – Communication Options • Be timely and credible; admit what you do and don’t know; advise audience you’ll update • them asap • Local Press Information Officer (PIO) needs to talk to State’s PIO who talks to CDC’s PIO • Local, State, Federal levels need to communicate the same message • Other PIOs for other parts of city/town government? One should be designated as The • Voice • Prepare basic message templates in advance • Have lists of key contacts available in fax/phone/email format for rapid use • Ensure contact with local/area MDs to talk about their possible role; a State • responsibility? • Ensure contact with local/area large businesses • Consider regional communication approaches with your neighboring jurisdictions

10. Summary • Focus on key issues: staff, vaccine, communication • Work with partners – the issues demand a team approach • Be flexible • Start NOW, if you haven’t already

11. Questions? • Anne Bailowitz, MD, MPH • Anne.Bailowitz@baltimorecity.gov • 410-236-9285