Patients who want the H1N1 vaccine need to be triaged

by Kairol Rosenthal

I am a young adult cancer patient who waited five and a half hours for the H1N1 vaccination along with 1200 other Chicagoans in a city college hallway. I do not have the trained eye of a public health analyst, yet it was easy to spy the glaring flaws that occurred in the whimsical distribution of this short supply vaccine. One of these oversights was the absence of trained workers screening citizens to determine if they actually needed a shot.

In the midst of what the government is calling a pandemic, there was a stunning lack of triage. Anyone could wait in line and receive a shot no questions asked. The public health department merely instructed citizens to use a common sense approach: If you consider yourself high-risk, get a vaccination.

I am an extremely aggressive patient with a high level of health literacy. As the author of a book on young adult cancer, I strongly advocate for patients participating in our care and knowing our bodies. However, I am not a doctor and medical practice is not common sense knowledge. Determinations of whether a patient’s underlying medical condition puts them at high-risk for complications from influenza should have been made by trained medical professionals, not by citizens making nebulous judgment calls.

Tensions ran high in the hallway of the makeshift walk-in clinic as my linemates and I vied for low cue numbers. People cut in front of each other, police mediated shouting matches, and camera crews interviewed desperate patients. My linemates and I began discussing our ailments, each defending our high-risk need for the shot. The 51-year-old man in front of me thought he was at risk due to high blood pressure that sometimes limits his use of over the counter medications. One woman in her late fifties boasted she thought she had a predisposition for bronchitis. Were these accurate self-determinations of the need for the vaccination or were my linemates pilfering from the short supply?

A look of guilt crossed their faces when I told them I am a cancer patient. “You should stand in front of me,” the gentleman said. But who should stand in front of me? Are toddlers and asthma patients at the end of the line less needy than me, a refractory thyroid cancer patient with two incurable tumors in my neck? And did the man with high blood pressure belong in line at all?

I did not have to second-guess my decision about whether to receive a vaccination; my primary care physician recommended I get vaccinated. But many Americans do not have the luxury of access to a primary care physician. This is why we need public health workers screening patients at walk-in clinics and prioritizing risks. As we scrutinize the government about the availability of H1N1 vaccination, we also need to question the lack of discretion they are using in distributing this much needed serum.

Kairol Rosenthal is the author of Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s, and blogs at Everything Changes.

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  • R Watkins

    Sorry, but in today’s legal climate, it’s impossible to refuse to give a flu vaccine to someone who requests it. If you don’t like it, talk to the trial lawyers.

  • Peggikaye

    Tomorrow, a local church is running an H1N1 vac clinic for the elderly and those with health issues that are qualified. They are only taking children who are at risk with medical conditions, not age alone (asthma, etc)

    But, they will not provide places to sit while waiting. They said to expect to stand in line up to 4 hours. My husband has Post Polio Syndrome. I have Myasthenia Gravis and Lupus …neither of our pain levels will allow us to stand for 4 hours … and the weakness from MG or Post Polio would have us on the ground long before the pain did us in.

    When I asked what accomodations there were for those with disabilities I was told “the flu vaccine clinic IS the accomodation”

    It doesn’t do any good if you can’t get to the vaccine …

  • http://everythingchangesbook.com/ Kairol Rosenthal

    R Watkins – Citizens are refused publicly funded medical services all of the time because they do not meet the criteria of certain programs. One way of not denying anyone is to make priority groups that go first. (Some vaccination centers allow pregnant women to go first.) If you have priorities, you are not excluding anyone, but saying that those who need it the most go first, those who need it the least can get the remainder.

  • http://www.twitter.com/saltzberg Stephanie

    Kairol: Well said, and thank you Dr. Pho for posting this to your blog. I also do not understand where the disconnect is, but there certainly is one, and as you point it it goes far beyond raw number of doses available. My mother is a chronically ill cancer patient in Massachusetts. She cannot physically wait in line a clinic for a shot, and must receive it at her health care facility which administers her chemo. However, they have yet to receive doses there. She’s actually been told that they don’t know when she’ll get it.

    So have I. However, I am healthy, without a suppressed immune system, and I would gladly pass along a dose to someone like Kairol or my mother if I had the option. I live in in the DC metro area, where around here there are clinics at malls, health care facilities, etc. that seem to be serving perfectly healthy people. I hear on the news radio stations updates every day about how many doses different counties will have. Fairfax County’s Twitter account actually lets people know how many they have and when they run out.

    I am a rational person, and I understand that there are challenges with mass producing this vaccine. But seriously, police mediation? Pushing and shoving? It’s really sad that there is such a lack of effective communication surrounding this important issue. And, of course, that perfectly healthy people — or those unaware, by no fault of their own, that they are not at as high of risk — because of their ability to wait in line, will be vaccinated first.

  • http://www.diabetesdaily.com/blogs/fadingtogray Christine

    I have severe asthma, type 1 diabetes, and am an RN in a bone marrow transplant unit. I struggled to find the H1N1 vaccine until eventually my work place received a limited supply of the vaccine- which we luckily got first dibs at. Then I see news articles about banks buying their own supply for their employees. I just about screamed at my computer screen.

  • zoe

    I am surprised that everyone seems to assume that flu clinics are the way to get your vaccine. Even though not every person in the United States has a primary care physician, the majority of people in the highest risk category do have some sort of medical home. In my area, no physician office has been given any vaccine. The obstetricians, the pediatricians, and the internists are still waiting for their first opportunity to vaccinate the pregnant women, the asthmatics, at others at risk for complications in their own safe and trusted (and handicap accessible) locations.

  • http://advancedmediterraneandiet.com/blog/ Steve Parker, M.D.

    You expect our polititians and government bureaurocrats to do a good job distributing the vaccine?

    “First come, first served” is probably a better system. It’s sad.

    -Steve

  • Peggikaye

    Zoe, in our area there have been no doctors to give vaccine either, it’s all health dept or flu vaccines clinics orgainized by the state. The doctors offices are waiting. We’ve checked with my PCP, Pulmo, Neuro, Ortho (just a shot), gyno, and rheumy ..but none are available, and they do not expect to get it in.

  • Gene

    “But many Americans do not have the luxury of access to a primary care physician.”

    If a primary care physician is already a ‘luxury,’ God help us all when insurance reform passes and the shortage really begins…

  • http://roseblum@aol.com GingerB

    People with access to care have all been medicalized to the point where no one is healthy.

  • Doc99

    Though the MSM are silent, it’s clear that the government’s handling of H1N1 is a total cluster f***. H1N1 is Obama’s Katrina. And we expect these bozos to take over Health Care? Our country’s in the best of hands.

  • http://thehappyhospitalist.blogspot.com Happy Hospitalist

    I got my H1N1 shot in 5 minutes, with no wait. Except my side effects scared me

    http://thehappyhospitalist.blogspot.com/2009/11/my-swine-flu-vaccine-side-effects.html

  • twaw

    anybody know if nancy pelosi and harry reid got their shots?

  • Moses2317

    Doc 99 – The reason why H1N1 vaccine isn’t widely available is because we left it in the hands of private industry, which is still using a 50-year old method to create the vaccine rather than the much newer methods used in other countries. Yes, our government should have overseen the industry more (or perhaps even have created the vaccine itself). But the core problem here is not government, it is that we left public health in the hands of the free market, something that it has little ability to deal with efficiently.

  • http://www.diabetesdaily.com/blogs/fadingtogray Christine

    My primary care doctor had the nasal spray, but not the injection. So I was out of luck there.