Quickly Noted: Mandatory Vaccination

Last week, a judge in New York state issued a temporary restraining order against a New York State directive ordering all health care workers to receive both H1N1 influenza and seasonal flu vaccines. Even the Reveres posted on the matter (and subsequently posted on something I’ve thought was a great idea for years, except instead of stickers, I say they should be forced to wear masks).

Now, I’m about as far from a lawyer as you can get, so take this with a grain of salt, but I thought that mandatory vaccinations weren’t a new idea:

See Jacobson v. Commonwealth of Massachusetts.

See school required vaccinations. (see Zucht v. King)

To me, the Jacobson case (while obviously ridiculously outdated) is comparable. In the face of a communicable disease outbreak that is actively causing excess disease and death, the state compelled one of its citizens to receive a vaccine that would protect the lives of those around them. Jacobson objected, and was forced to receive the vaccine in the interest of the PUBLIC’S HEALTH. Given that he was not performing head of bed procedures  on immuno-compromised patients or pregnant women, he actually had a better argument than nurses and healthcare workers against receiving the vaccine.

So what to do?

For me, I see no problem with mandating vaccination for influenza. Every year it’s proven to be safe. And for those that have a religious or philosophical objection, they can apply for an exemption. The exemption would require signing a document affirming that vaccines are the best way to prevent influenza transmission and that their refusal to receive a vaccine may permit the transmission of the potentially fatal disease in the healthcare setting. To wit, the healthcare setting, in order to protect itself from the liability that their employee is exposing them to, should require the worker to be masked while on the grounds of the campus (or office, etc.). Am I being unreasonable here?

Again, I’m no lawyer, so for a more reasoned approach on the matter, an anonymous (not me) letter was published earlier this year calling for a twenty-first century Jacobson v. Massachusetts (PDF direct download).

links for 2009-10-19

• Flu Data Shows Concerned Health Officials, Skeptical Public
  I try not to put too much political stuff on this site, but this is a really interesting post by a phenomenal flu blogger.
  (tags: pandemic h1n1 vaccine)

The Failure of H1N1 Communications

I’ve been thinking a lot about H1N1 communications lately.

I’ve yet to find a person that has spoken crossly about the CDC’s ongoing public information campaign, especially their work in social media. Don’t get me wrong, I don’t want to be that guy; I’m not looking to knock the work that CDC has done. Truly, I think they’ve done a great job. I can only hope that if I ever have to do something similar, I meet with the same level of success.

The thing is, I don’t know what a poor job would look like. I’m a firm believer that success is defined by failure, and vice versa. I don’t know if CDC, or any other public health public information folks, are doing a good job or a bad job because I don’t know what that looks like.

There’s a cool post on a blog that I found through Twitter called Walking the Path: Smashing Silos and Encouraging Collaboration in Health Marketing Communications. One particular post stood out to me. In this post, the author thinks the CDC did a good job on educating people about H1N1 by utilizing social media, but is dropping the ball on spurring people to action. Specifically, lots of people aren’t planning on getting the vaccine, which anecdotally seems like the case to me, too.

Is that what failure looks like?

Is it possible that H1N1 public information campaigns are more than just education campaigns? Is there a second component to H1N1 communications, one of convincing people to act?

One of my good friends, Ike Pigott, blogging at Occam’s Razr, posted recently on something similar. He noted (in a really cool post about using Posterous to develop a streaming information hub–really, check it out) that people are more willing to act when something is relevant to them. He likens relevance to local-ness, and I think he’s on to something. This might be why CDC’s efforts at getting people to get the shot aren’t working. A campaign written for a nation won’t help to get Jane Q. Public to get her kids vaccinated. One of the commenters  on the Path blog above also noted that social media is a great way to do this, though difficult.

By providing local information that’s pertinent to the intended audience and providing a method for direct feedback and a way to ask questions, local health departments can work to spur people to take the next step.

I think that’s the next phase in H1N1 influenza communications (or at least it should be). Move away from bullhorn risk communications. Begin engaging with your community. Right now, the best way I can think of to do that is to use social media tools — at the local level.

CDC should be offering webinars on how LHDs can set up Twitter accounts and how to record YouTube videos. The CERC folks should be developing curriculums to teach PIOs how to write using a social media voice. Health Commissioners should be scheduling live chatroom “office hours” where citizens and residents can ask them to address specific worries from the public.

I guess, then, I’m not saying CDC has failed in their H1N1 communication efforts. They’ve handled the first phase extremely well. Kudos, really. I think that believing they can  continue to communicate the same way going forward, in this second phase, is their failure. And there’s absolutely nothing they can do about it. The fact is, the CDC is just not equipped to act as a local presence everything, nor should they be. Pandemic influenza is, and has always been, a local emergency that just happens to occur everywhere. The response, by definition, should be locally coordinated.

Swine Flu, Where Art Thou

There’s a really interesting article on the front page (right now) of the New York Times about flu incidence rates across the country. For anyone who knows that flu incidence differs from state to state, county to county, city to city, and even neighborhood to neighborhood, this article will only surprise in how well it bears this maxim out. For everyone else, though, it’s a telling introduction into what flu planners, public health workers and PIOs have to deal with this season.

Flu is not like other public health preparedness topics. It does not plume and modelling its spread is notoriously difficult. An inefficient mode of transmission, combined with inconsistent replication does not make for a very linear progression of disease spread. Now add to that equation the idea that disease severity differs from person to person, ranging from hospitalized to any of a range of symptom presentations to essentially asymptomatic presentation, and you begin to get an idea of how hard it is to track flu. (That’s one reason why I’m so excited about Google Flu Trends – it allows people to self-identify flu symptomatology without forcing them to “commit to sickness” by going to the doctor’s office.

So, why is this important? Because with variability comes problems. In an athrax situation, everyone exposed has to take the same precautions; over time, while the danger to those exposed increases, the potential pool of exposed people decreases as the epidemiology of the situation improves. Same thing with a conventional attack: the number of exposed is finite, and the number of potentially exposed goes down over time. Flu situations are different, (especially mild flu situations), because too aggressive response seems out of place for a flu that, in the eyes of the public, isn’t that big a deal. Too timid a response, and you run into the same problem. (Not all infectious diseases are like this, a smallpox case could never be “under-responded to”

In a situation like ours, how do PIOs reconcile a national media that is pushing a “deadly flu” scenario, but there’s no flu in your city (like NYC, according to today’s article), and most of the country this past spring? How do you take years of pre-positioned message templates that spell out gloom and doom (mostly because of H5N1), and whip something together real quick, for a disease whose epidemiology changes daily, and for which CDC keeps changing their recommendations?

Vaccine for Everyone (in Indiana and Tennessee)

It seems a bit disingenuous to call oneself the only public health preparedness blogger out there and not blog about the biggest activation of public health preparedness programs across the US. While it would be easier to not say anything for fear of inferring what I spend nine hours a day doing, it’s not helping advance the state of those programs or efforts, and frankly, I’ve got too much to say.

So, I’m back(?).

The biggest thing I’m depending on is this fancy-dancy WordPress iPhone app that will let me blog whilst sitting in Schuylkill traffic. The only trade-offs are that I won’t get as much homework done, posts won’t have pictures, and they’ll probably be a bit shorter. At the very least, it’ll help get all of this commentary and these ideas out of my head.

Like all good serials that take the summer off, I trust that you remember where we left off last season. No sense in me walking you through the events of the last four months as you’ve probably lived them, especially if you’re reading this blog. And if not, the major dailies have catch-up pieces pretty regularly anymore.

The hot topic in certain circles yesterday had to do, obviously, with H1N1 vaccine (yes, I sold out and am no longer calling it swine). Specifically, folks are chattering about what’s happening in Indiana and Tennessee. Both states not only announced that they are receiving vaccine, but have also released where the first doses would be going.

This is unusual, and cause for out-sized discussion, because no other state, county or city that I’ve heard of is announcing that information. My first thought when hearing about the announcement was to shake my head. Did they not think that the media would swarm those sites and the public would demand they get the vaccine first?

And then I thought about what I always preach here, be transparent and trust in the public. And that’s just what they’re doing. They’ve told the public, before anyone asked or there was any outcry, exactly what was going on, and trusted that they would be satisfied with the explanation that more was on its way, and everyone would have their opportunity to get a vaccine.

This situation reminds me of a post from the Crisisblogger, writing for Emergency Management Magazine, that I read this morning. Mr. Baron talks about what Dave Letterman is going through right now, and while chastising his, erm, lifestyle choices, he notes that Letterman’s decision to admit what happened on national TV, may have restored some people’s respect for him. Transparent, trust the public.

Time will tell if either decision was the right one, though (putting aside Letterman) at least IN and TN are trying something different – something that has the chance to rebuild faith in government. Kudos!