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NYC DOHMH Was Not Wrong to Give H1N1 Vaccine to Wall Street Firms

November 6, 2009

Better bloggers than me say that you need a catchy title to your posts – something that will stir conversation and get people’s dander up. I can’t imagine that this one won’t.

By now, I’m sure you’ve all heard about the latest. And if not, I’m sure it will hit the national press soon enough. Several large Wall Street firms have begun receiving H1N1 vaccine from NYC Department of Health and Mental Hygiene to distribute through their employee health units to high-risk employees. Apparently, BusinessWeek broke the story here.

Once that happened, hue and cry. A sternly worded letter from the former NYC Health Commissioner and current CDC Director, investigations are being called for, Senators are writing letters, the whole nine yards.

Rightly or wrongly, I think that NYC DOHMH, CDC and Wall Street are going to get raked over the coals for this. CDC and Wall Street can take care of themselves, but NYC DOHMH will probably come out of this the worst of the three, and they’re the ones least at fault, in my opinion.

Besides all that, I think that giving H1N1 vaccine to large employers with on-site healthcare infrastructure is not the part we should be upset about. In fact, I’m surprised that this hasn’t happened other places already, and I’m positive that it will happen again, and more times, across the country. Maybe not bankers next time, but maybe large manufacturers, etc.

Why?

Because public health departments have been charged with distributing hundreds of millions of courses of vaccine, and they can’t. They simply don’t have the infrastructure. Not enough manpower, not enough drivers, not enough cars, not enough refrigerators, not enough forms, not enough databases, not enough data entry folks, not enough vaccinators, not enough anything. And then along comes a company that says, we have 10,000 people working for us. Give us vaccine and we’ll take care of all of them and their families. Free of charge. Set it and forget it. Take your time and concentrate on the poor, the destitute, the infirm, the non-English speakers, the unemployed, the sick. That’s what public health departments do best anyway.

Boy, I’ll tell you how good that must look to an overworked overwhelmed public health department. And if New York City is doing it? If the best funded and best staffed health department in the country is doing this, I can assure you that other cities, counties and states are doing it.

So, let’s examine the real problem here. The real problem is the same problem that Trust for America’s Health yells about every November. It’s the same problem I’ve yelled about before. After thirty years of budget cuts, hiring freezes, matching grants, new spending only, supplement not replace, preparedness only, first on the chopping block, public health is little more than skin and bones. Public health departments can’t do their job on a normal day, let alone when 10 to 15% of the public is showing up at emergency rooms, vaccine is rolling in and out of the building all day every day, the media calls, the conference calls, the reporting requirements. Imagine all that. And then along comes a company that says, we have 10,000 employees people working for us…

What we’re witnessing is no more than the absolute failure of the United States public health system.

After decades of being stretched and chronically underfunded, after warnings that someday something’s gonna happen, after  letting the infrastructure rot, it finally did happen. A real public health emergency. And the CDC and HHS said that it was a local matter, and we’ll give you all the vaccine you need—more even–, but you’ve got to handle all of the boots-on-the-ground stuff yourself. And the states and counties dusted off their panflu plans and diligently crafted public information messages, and scheduled flu shot clinics and told their surveillance guy to ramp it up for a bit until we get a handle on things. And then they found that none of our previously developed messages worked. And then they had to cancel all of their flu shot clinics cause they didn’t have any vacccine. And then the surveillance guy collapsed from working 12-hour days for 2 months straight. And when the vaccine finally showed up, they only got a third of what they were promised. And then the contract nurses they hired to help out didn’t show up to work and somebody had to cover for them. And then along comes a company that says, we have 10,000 employees people working for us…

In a perfect world, would I be appalled by this turn of events? That Wall Street got their flu shots first? Absolutely disgusted.

But this is far from a perfect world. And while the priority groups were set for a good reason, the fact of the matter is that folks in those priority groups have to catch the flu from somewhere, and I’ll bet that some of them catch it from bankers. Vaccinating everyone decreases the incidence of disease; it decreases the chances that that pregnant woman, or that child, or that asthmatic, will catch the flu. And really, isn’t that the ultimate goal? To keep people from getting sick? When you’re fighting with one hand tied behind your back, do you question who it is that just gave you a baseball bat? No, you grab it and swing for the fences and hope for the best.

The valuable lesson we’ve all learned today? Underfunding public health is the same as undermining public safety. And not in some bioterrorism/emergency preparedness way. In a people get sick and die from a natural disease kind of way. In a traditional public health can, has, and will save lives kind of way.

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6 Comments leave one →
  1. November 6, 2009 9:13 am

    Hello Jimmy … I can’t really comment on the situation south of the border. But here in Canada, especially in Ontario, we face the same kind of challenges re: capacity of our public health agencies. Our experiences though, have been shaped by SARS … and despite that fact, the general agreement is that we could have done much better in the current pandemic.

    Logistics and communications seem to be the major issues. And now, we also face the same perception problems with professional hockey players and coaches, hospital board members and others, jumping the queue to get their flu shot. Clearly, the perception is awful in a country and provice with a public, universal health care system.

    But to me, more worrisome, is the lack of consistency in messaging to the public between the different parts of that health systems. The result is confusion and fear for a lot of people.

    • November 7, 2009 11:37 am

      Patrice:

      Thanks so much for stopping by. Here in the US we’re starting to see some people question our federal government for promising to have enough vaccine for everyone by now. Promises they evidently couldn’t keep (irrespective of who is to blame for the delay). I think that in hindsight, we’ll notice how much of a bullet we dodged with this being a relatively mild flu pandemic. If this was a more killer pandemic, and responded as we did, it could’ve been horrific.

      And you know that I agree with you that hopefully we’ll have learned something from the inconsistent messaging. You mention between health systems, but I also worry about the inconsistency over time. A prime outcome of Crisis and Emergency Risk Communication is the acceptance that it’s okay to say, “We don’t know,” or, “We’re not sure.” Nobody I know has done that. It’s always been, “It’s mild, we’ll be fine,” or, “We’ll have plenty of vaccine for everyone,” or, “We’ve got a walk-in clinic set up for tomorrow,” only to cancel it that morning because there is no vaccine.

      It amazes me how constant the need, in our societies, to push the well-to-do to the front of the list for scarce resources. The need must exist in all cultures, apparently. That’s why I was so impressed that President Obama refused the vaccine for himself and his wife. It was only in the news a day, but it spoke volumes to me.

      Thanks again,
      Jimmy

      • Justine permalink
        November 19, 2009 8:48 pm

        Well said, Jimmy. Thanks for a great post. As far as your comment about no one following the golden rule of saying “We don’t know,” I actually feel the CDC has done a great job of doing this for the most part. I am frequently on their calls with local health departments, and I think their messaging has been consistent. They say “we’ll let you know when they can” quite frequently, and then they do. But there is no arguing the mark was missed big time on the vaccine release.

  2. November 6, 2009 12:48 pm

    Since most of the stories on this have been an extension of the “Wall Street is the source of all wrongs in the world” line I haven’t been able to find much detail about the program involved. Specifically, was this a planned distribution, taking advantage of the private sector providers the same way the Federal government uses Federal Occupational Health to deliver vaccinations to employees at work, or was it more the way it sounds in your post – the companies reaching out after the fact and offering help? When I was in local public health we worked very closely with the largest employers in the area to take advantage of their resources for this type of event. The amount of paperwork and legal forms involved made me glad that the director of emergency preparedness for the department was a lawyer and I didn’t have to go anywhere near that side of things.

    Taking advantage of existing occupational health programs through partnerships makes sense. In this specific instance, with the very narrow priority groups and the lower than dreamed of production rates, it may not have been the right call to make.

    • November 7, 2009 11:46 am

      Unfortunately, Joel, in the cacophony of self-righteousness, it seems that details like the truth tend to get drowned out. Out of everyone I know, you’re probably the person best positioned to find that out.

      If the goal of a vaccination campaign is to get everyone vaccinated, and you utilize (fairly, not just the richest or most powerful) large health distribution networks to give out vaccine, and it’s done according to the proscribed recommendations (another thing that got lost in the cacophony–no one seemed to wonder why Citigroup only requested 1,000 doses for the tens of thousands of people that work there, maybe they were going to give it to the pregnant women, new parents and people with chronic health conditions that made them vulnerable), I have no problem with the effort. It’s just the selfish indignation and headline writers who posture.

      That said, according to the latest update from CREW (http://citizensforethics.org/node/43248), Morgan Stanley said that they’re donated the 1,000 doses they received to local hospitals who hadn’t received any. That gives me pause, because I would think that all hospitals should have received some before anyone else, per NIOSH guidance.

      I guess, though, we’ll never know the whole story and never be able to learn from it due to NYC DOHMH getting shouted down and spanked on national TV. Shame.

      Good hearing from you, as always,
      Jimmy

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