The top public health official in Los Angeles County stood at a swine flu vaccination site in Compton, Calif., on Tuesday and gently told elderly residents that they really ought to go home.
“I explained to people 65 or older, ‘The reason we are doing this is for children,’ ” said the official, Jonathan E. Fielding, the director of the county’s Department of Public Health. “I told them: ‘They are at very high risk for this flu, and you’re at low risk. I am sure you wouldn’t want to get a shot that left a kid who is at risk in harm’s way.’ ”
People have lined up in Southern California and across the country in recent days in the hope of getting a prick in the arm, but a dearth of the H1N1 vaccine has created an unexpected dynamic: local government officials, hospital workers and doctors in private practice are being conscripted as ad hoc swine flu police.
The goal is to make sure that those Americans with the highest risk for contracting the virus — and experiencing the more dangerous complications that can ensue — get injected first. But the somewhat willy-nilly nature of the vaccine’s distribution in some areas, publicity surrounding President Obama’s declaration of a national emergency and the rather large population legitimately considered high risk have brought hundreds of thousands of people to vaccine distribution points.
Some people beg. Some reduce themselves to lying about a pregnancy, or an underlying medical condition, that would move them ahead of the pack. In any case, officials say it is virtually impossible to verify most of the claims.
“We have made it very clear as to who we believe should go to the front of the line,” said Thomas W. Skinner, a spokesman for the Centers for Disease Control and Prevention, who added, “There very much is an honor system here in place with us relying on the general public to do the right thing and step aside.”
On the one hand, each vaccinated person is one less carrier of the flu, regardless of individual risk. On the other, government officials have set unambiguous priorities based on who is most vulnerable: pregnant women, people who live with or take care of infants under 6 months old, health care workers, anyone 6 months to 24 years of age and people who are older than that but have underlying health problems that make them susceptible to influenza-related complications.
In Chicago, hundreds of people snaked through the hallways of a city college on the southwest side even before the swine flu vaccine clinic there opened on Tuesday. Just 10 minutes after its opening, 760 of 1,200 available appointments for an injection had been reserved.
Ilissa Shefferman arrived at the vaccination site more than an hour before the doors opened with her 8-month-old daughter. Ms. Shefferman, 36, a stay-at-home mother, brought documentation that she was asthmatic just in case she had to prove it. As she surveyed the line, she said she was annoyed to see people who appeared not to be in the risk groups. “If they’re not high-risk, they should have respect for those who are,” Ms. Shefferman said.
Another person in line, Bill Wenthen, who is 50, brought his young daughter to get vaccinated and said he would try to get the vaccine himself if the medical staff would allow it, even though he was not part of the high-risk population.
“I’ll go for it if they let me,” Mr. Wenthen said.
Dr. Julie Morita, the medical director for the Chicago Department of Public Health’s immunization program, said the department expected to vaccinate about 7,000 people on Tuesday. Women who were visibly pregnant and people in wheelchairs would be allowed to move to the front of the line. “One thing we learned is that we don’t want late-term pregnant women sitting around waiting for hours,” Dr. Morita said.
The disease control centers have sent out 22.4 million doses of the H1N1 vaccine across the country through a central distributor that gets the drug from the four manufacturers, allocated to each state on a per capita basis. While the centers resist predicting when supplies might increase, the agency insists the vaccine will be much more widely available in the coming weeks.
States distribute the vaccines to health care providers and local health departments, which in turn dole out the supplies to those best situated to reach high-risk populations. But officials acknowledge that reaching the most at-risk population is anything but an exact science.
“It’s perfectly understandable that people are worried about this flu,” said Dr. Paul Jarris, the executive director of the Association of State and Territorial Health Officials, representing health officers of the 50 states. “We aren’t going to give people pregnancy tests to see if they need the vaccine.”
Some states and cities — including New York City, which begins to roll out its school vaccine program on Wednesday — have chosen to focus on distributing vaccines primarily through schools, so that children can be roundly immunized. Other states, like Tennessee, initially focused heavily on health care workers.
Dr. Michel Cohen, a pediatrician at Tribeca Pediatrics in New York, said he had limited his doses to children with extremely high risks, like cystic fibrosis and serious asthma. No others were permitted a shot, he said. “People will go crazy,” wanting one for their own child, Dr. Cohen said.
In Los Angeles County, local providers — with a priority given to obstetrician’s offices and pediatric practices — got 200,000 of the 300,000 vaccines distributed through the county health department, and the rest have been distributed through makeshift clinics run by the county, in another practice common across the country.
On Tuesday, Wendy Gimenez, 33, stood with her son and two other friends from Orange County, Calif., in a community college in Compton to get shots for their children. “Two people in front of us got turned away,” Ms. Gimenez said. “It was a man and a woman. She said, ‘If I put my little sister with me, can I get in?’ They said, ‘No, sorry.’ She just kept saying, ‘If I do this, if I do that, can I?’ But they were turned away.”
Health care officials say there are downsides to being overly zealous in policing who gets immunized, as was demonstrated in the 2004 flu vaccine shortage when high-risk adults bowed out to make room for others.
“When you prioritize too tightly, even people in the priority groups did not get vaccinated,” said Dr. Jane R. Zucker, assistant commissioner of the Bureau of Immunization for the New York City Health Department. “That is a risk we do not want to take.”
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