The U.S. government's $6.4 billion swine flu vaccination program is likely to put the American public health sector under unprecedented strain and expose serious shortcomings, experts say.
As the first mass U.S. immunization program in a generation ramps up to deliver tens of millions of doses each week, public health experts disagree about how well the country's network of state and local health departments might perform.
But many say the sector never received the money it needed for large-scale immunizations despite years of planning for pandemics after the reemergence of bird flu in Hong Kong and South Korea in 2003.
"The worst-case scenario is that there is vaccine in a particular state or locale but that state or locale hasn't sufficiently planned to distribute it," said Leonard Marcus of the Harvard School of Public Health.
Marcus, who studied the 2005 Hurricane Katrina disaster, said the H1N1 immunization program could encounter similar breakdowns in leadership and coordination wherever local public health systems are underfunded or poorly managed.
"Some bureaucrat is going to say he doesn't have authority or needs a signature and it's going to stop the system from moving. That could very well cause panic," he said in a telephone interview.
Experts give the Obama administration high marks for creating a program capable of procuring 250 million doses and distributing them to 90,000 sites nationwide so that every American who wants the vaccine can get it.
The government has ordered vaccine from five companies -- Sanofi-Aventis SA, CSL Ltd, Novartis AG, GlaxoSmithKline and the AstraZeneca unit MedImmune.
"RUSTY FAUCET"
Bob Hutchens, a vaccine distribution expert with consulting firm Booz & Co, expects overall success.
"There will be some long lines, there may need to be some late hours and people may not be able to get it the day they want it," he said. "But if we approach this soundly and rationally, I suspect we'll be just fine."
But with the United States struggling to recover from an economic recession, staffing could be an issue.
Local health departments eliminated 8,000 positions in the first half of this year, after 7,000 job cuts in 2008, according to the National Association of County and City Health Officials. Another 12,000 employees have been subjected to reduced hours or mandatory furloughs this year.
The Association of State and Territorial Health Officials says three-quarters of states have cut public health funding this year, while 61 percent expect smaller budgets in 2010. Seven states have cut back specifically on immunization.
Layoffs have targeted people needed for the H1N1 program -- nurses, nurse's aides and switchboard operators and receptionists who would help field public queries.
"The problem is that there's a big rusty faucet at the end of the vaccine pipeline," said the University of Minnesota's Michael Osterholm, who warns public fears could flare quickly if H1N1 overwhelms hospitals and their intensive care units.
A poll by the American College of Emergency Physicians says almost 90 percent of emergency room doctors worry hospitals could have a hard time responding to a surge in H1N1 flu.
"Public health is the life raft," Osterholm said. "But are they big enough to get everybody on board and how will they navigate those rough waters?"
Experts were careful not to criticize the caliber of public health staff, widely respected for their energy and devotion.
But they said meager resources, combined with the scale and speed of the national immunization program, will bring unprecedented strains.
FRAYED NERVES
That could mean bad news for 46 million Americans with no health insurance, who could flood public health offices where vaccinations will be free.
"It could overload some systems in terms of staffing and frayed nerves," Hutchens said.
The Obama administration has sought to smooth the program's path by giving health departments and hospitals $1.4 billion to help plan and implement the vaccination effort, including the hiring of additional staff and contractors.
"We can't do this ourselves," said Fran Phillips, deputy secretary of Maryland's public health services, whose staff has assembled 3,000 private vaccinators to supplement two-dozen local public health departments. Maryland has received $24 million in federal grants to help with the effort.
Preparations appear to be less uniform in states like Michigan, where much of the authority rests with local health departments. Michigan received $34 million in federal money.
"They're really in the process right now of utilizing the funds, hiring folks or contracting with vaccinators," said Dr. Eden Wells of the Michigan Department of Community Health.
"It's too early to make a judgment about whether the (federal) money is enough."
As the first mass U.S. immunization program in a generation ramps up to deliver tens of millions of doses each week, public health experts disagree about how well the country's network of state and local health departments might perform.
But many say the sector never received the money it needed for large-scale immunizations despite years of planning for pandemics after the reemergence of bird flu in Hong Kong and South Korea in 2003."The worst-case scenario is that there is vaccine in a particular state or locale but that state or locale hasn't sufficiently planned to distribute it," said Leonard Marcus of the Harvard School of Public Health.
Marcus, who studied the 2005 Hurricane Katrina disaster, said the H1N1 immunization program could encounter similar breakdowns in leadership and coordination wherever local public health systems are underfunded or poorly managed.
"Some bureaucrat is going to say he doesn't have authority or needs a signature and it's going to stop the system from moving. That could very well cause panic," he said in a telephone interview.
Experts give the Obama administration high marks for creating a program capable of procuring 250 million doses and distributing them to 90,000 sites nationwide so that every American who wants the vaccine can get it.
The government has ordered vaccine from five companies -- Sanofi-Aventis SA, CSL Ltd, Novartis AG, GlaxoSmithKline and the AstraZeneca unit MedImmune.
"RUSTY FAUCET"
Bob Hutchens, a vaccine distribution expert with consulting firm Booz & Co, expects overall success.
"There will be some long lines, there may need to be some late hours and people may not be able to get it the day they want it," he said. "But if we approach this soundly and rationally, I suspect we'll be just fine."
But with the United States struggling to recover from an economic recession, staffing could be an issue.
Local health departments eliminated 8,000 positions in the first half of this year, after 7,000 job cuts in 2008, according to the National Association of County and City Health Officials. Another 12,000 employees have been subjected to reduced hours or mandatory furloughs this year.
The Association of State and Territorial Health Officials says three-quarters of states have cut public health funding this year, while 61 percent expect smaller budgets in 2010. Seven states have cut back specifically on immunization.
Layoffs have targeted people needed for the H1N1 program -- nurses, nurse's aides and switchboard operators and receptionists who would help field public queries.
"The problem is that there's a big rusty faucet at the end of the vaccine pipeline," said the University of Minnesota's Michael Osterholm, who warns public fears could flare quickly if H1N1 overwhelms hospitals and their intensive care units.
A poll by the American College of Emergency Physicians says almost 90 percent of emergency room doctors worry hospitals could have a hard time responding to a surge in H1N1 flu.
"Public health is the life raft," Osterholm said. "But are they big enough to get everybody on board and how will they navigate those rough waters?"
Experts were careful not to criticize the caliber of public health staff, widely respected for their energy and devotion.
But they said meager resources, combined with the scale and speed of the national immunization program, will bring unprecedented strains.
FRAYED NERVES
That could mean bad news for 46 million Americans with no health insurance, who could flood public health offices where vaccinations will be free.
"It could overload some systems in terms of staffing and frayed nerves," Hutchens said.
The Obama administration has sought to smooth the program's path by giving health departments and hospitals $1.4 billion to help plan and implement the vaccination effort, including the hiring of additional staff and contractors.
"We can't do this ourselves," said Fran Phillips, deputy secretary of Maryland's public health services, whose staff has assembled 3,000 private vaccinators to supplement two-dozen local public health departments. Maryland has received $24 million in federal grants to help with the effort.
Preparations appear to be less uniform in states like Michigan, where much of the authority rests with local health departments. Michigan received $34 million in federal money.
"They're really in the process right now of utilizing the funds, hiring folks or contracting with vaccinators," said Dr. Eden Wells of the Michigan Department of Community Health.
"It's too early to make a judgment about whether the (federal) money is enough."
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