JEFFERSON CITY — As the first H1N1 vaccine arrives in Missouri, the Missouri Department of Health and Senior Services is leaving it up to local health agencies to decide who will and who will not receive the medicine.
"Every county is different," Health Department spokesman Kit Wagar said. "We think that the local health departments know best how to get (the vaccine) efficiently out to the public."
According to representatives from several local health departments, nearly 20,000 doses of FluMist, a nasal vaccine for the novel H1N1 flu virus, should arrive in Missouri within the week. Local health departments have placed orders for the vaccine based on their population. It is up to those departments to distribute the vaccines to local hospitals, clinics, doctors' offices and schools.
Missouri was allocated 35,000 doses, but many providers chose not to take this week's shipment.
In Boone County, the Public Health and Human Services Department has ordered 900 doses of the vaccine — the maximum number the state Health Department allotted the Boone County department based on the number of children and first responder health care workers in the area. That means fewer than one in 100 residents can be vaccinated this week.
Each local health department may receive 100 doses of the vaccine from the state. Additional vaccines are distributed based on population demographics, including the number of children ages 2 to 4, the number of first responders and the number of people who have contact with children under 6 months old, said Jeff Hershberger, spokesman for the Kansas City Health Department.
The state receives vaccines from the Centers for Disease Control and Prevention, which distributes vaccines to states based on population as well.
"This first shipment is really very small. A lot of providers said, 'The portion that's coming to me is too small (so) I don't want to hassle with it. We'll just put in our order the second week when we can get a much bigger shipment,'" Wagar said. "This was their choice."
The available amount is small because the vaccines have only been in production for a week or two, Wagar added.
"We couldn't even put any orders out until last Wednesday," he said. "For people to expect this to be on the street already, that's a little unreasonable. This stuff has to be shipped."
Other local health departments are taking different approaches in distributing their vaccines.
John Shelton, a spokesman for the St. Louis County Department of Health, said a number of its 5,000 doses of the vaccine will go to schools and doctors' offices, but several will also go to hospitals — not for public distribution but for hospital staffers and other first responders. The vaccine will also be available in three public clinics.
The Missouri side of the Kansas City metropolitan area, along with a few surrounding counties, is expecting a total of 7,100 doses. The Kansas City Health Department is focusing primarily on vaccinating young children rather than first responders or giving vaccines to clinics.
"Different jurisdictions are reaching out to different high-risk groups, but our reach is pediatric groups," Hershberger said.
Health care providers were invited to distribute the vaccine, but until the caps are removed somewhere down the line, local officials are responsible for serving priority groups as set by the CDC. Priority groups include young children and older school-aged children with existing health problems as defined by the CDC.
Although pregnant women are a priority group, they will have to wait until a preservative-free vaccine becomes available later this month.
While the first shipment won't cover most Missouri residents, more doses are on their way to the state, Wagar said. Next week Missouri will take in 70,000 doses of the vaccine, with nearly 300,000 to come the week thereafter.
Many local health care providers have been calling with questions on the process for receiving and distributing the vaccines, Shelton said. Some doctors have said they haven't been informed of how they'll receive the vaccines or who they're supposed to distribute them to.
"We have sent numerous health updates; we have got this posted all over our Web site. If they don't know, they haven't been trying," Wagar said.
Health care providers chosen to assist a local health department must sign an agreement saying they will serve priority populations, have enough refrigerator space to house the vaccine, keep them at the proper temperature and test the temperature with a calibrated thermometer.
Providers must also agree not to charge for the vaccine (the federal government is funding the vaccine's dispersal), but they can charge for administrative costs, such as the nurses' time. All vaccinations must be administered by a health care professional.
Asked whether recent departmental cutbacks would affect the state Health Department's ability to monitor the process of distributing the vaccine, Wagar said they "should not get in the way of any effort to get (the vaccine) out."
"One of the reasons we have
chosen to do it the way we have — where you're having it shipped
directly to the local health departments from the manufacturer or from
the manufacturer to the health care providers — is that we saw no reason
for the state to be handling these vaccines," he said.
"It was much faster just to have the manufacturer ship them to where they're going to be given directly to the public."