H1N1: Baddeck breakdown

For a process that has (or should have) undergone intensive preparation for months, the Cape Breton District Health Authority’s first public H1N1 vaccination clinic, Wednesday in Baddeck, was an organizational disaster. Here’s how one Contrarian reader described it:

I gathered the kids after school and navigated our way through the car-lined streets to the Masonic Hall. We grabbed a spot at the end of the line, several car-lengths back from the corner of Queen & Grant streets. It was typical Cape Breton gathering—lots of chatting and laughing between neighbours, and new friends made with unfamiliar faces.

Many of us who arrived after 3 were parents and we had our kids with us. My kids played “Where’s Waldo,” by finding teachers in the line up. Ahead of me were a young couple with their 15 month old daughter. After an hour, we had inched our ways forward several steps.

Behind me were several older people from the community, including at least one with a walker. We all stood, shoulder to shoulder, four in a row, many doing a two-step to keep warm. By the 1.5 hour mark, the sun had slunk low in the sky, and the wind was much colder. A young mother, who had spent the last hour and a half chasing her toddler, fainted. She was carried inside, while someone held her baby.

While I didn’t mind waiting two hours for the shot, I do wonder if asking people who have young kids, are old and infirmed, to stand outside for two hours, is wise. I also wonder if a clinic like this could not have been set up at the school. There would have been facilities for kids and it would have captured kids, parents and teachers in addition to other members of the community. And those waiting would have been warm inside.

Baddeck is Contrarian‘s county seat. Having been warned about the long wait and the cold, I bundled up in layers and made the hour’s drive to Baddeck, arriving an hour before the clinic’s published closing time. A security guard refused to let me join the lineup. It had been closed, even though the clinic hours had been extended until 7. Contrarian spoke with people who arrived at 10:30 a.m (90 minutes before the scheduled opening), at 3, and at 4:30. All waited in the cold more than two hours. Among other things, they reported that the “informed consent” video all were supposed to “watch,” was hard to see and impossible to hear.

Is there a better way to do this?

Douglas Shenson, associate clinical professor of epidemiology and public health at the Yale School of Medicine, thinks there is. In Monday’s New York Times, he suggested using federal polling stations for rapid, mass vaccinations:

There are about 186,000 polling places in the United States, in schools, centers for the elderly, churches and fire stations in every community. Federal law requires that they be accessible to people with disabilities, many of whom may be particularly vulnerable to influenza…. Public health officials must soon decide how and where to deploy health care personnel to administer the H1N1 vaccine. If the pandemic becomes more severe, they will need to deliver the vaccine to large numbers of people while avoiding crowds that would increase the risk of infection. Sites that are universally available and dispersed across all neighborhoods would be ideal.

Shenson and some colleagues piloted the idea in last fall’s US presidential election on behalf of the Robert Wood Johnson Foundation’s Vote and Vax initiative.

Would this work in Canada? By my back-of-the-envelope calculation, we have roughly 200 polling stations per riding, or more than 80,000 across the country. That’s about five times as many, per capita, as the US (which may be one reason why our paper ballot elections work so much more smoothly than their machine-assisted votes!). Realistically, it may be too many venues for public health officials to staff.

But for anyone who wrangled toddlers or aging parent for two hours in the cold yesterday, having more, smaller clinics, and having them in accessible buildings that can handle a crowd, seems at least worth considering.