By Stephen Smith, Globe Staff | August 13, 2009
Massachusetts health authorities took the unprecedented step yesterday of deputizing dentists, paramedics, and pharmacists to help administer vaccines against both the seasonal flu and the novel swine strain expected to make a return visit in the fall.
In another emergency measure, regulators directed hospitals and clinics to provide vaccineto all their workers and some volunteers, a move designed to keep the medical workforce robust and prevent doctors and nurses from making their patients sick.
The actions illustrated the intensifying sense of urgency as health authorities, hospital administrators, and clinic executives across the nation confront the prospect of providing hundreds of millions of doses of vaccine against not one but two deadly types offlu in the same season.
“It’s a huge burden of work; there’s no doubt about that,’’ said Dr. Jay Butler, director of the swine flu vaccine task force at the US Centers for Disease Control and Prevention.
In Massachusetts, disease specialists are expecting to provide up to 9 million flu inoculations within the next few months, three times as many as last flu season,because of the need to give two doses of swine flu vaccine.
In Boston, the city health agency plans to offer shots during the day, night, and weekend. There is a chance that retired health workers will be pressed into service to provide vaccinations to adults and children, with manypatients needing three visits for all their inoculations.
Knowing they are in a race against viruses that emerge suddenly and spread swiftly, private medical practices are also bracing for an onslaught. At Harvard Vanguard Medical Associates, part-time employees will be asked to work longer hours to deliver half-a-million vaccine doses so that doctors can focus on tending to the ill.
“It’s going to require all hands on deck,’’ said Dr. Alfred DeMaria, the top disease tracker at the state Department of Public Health. “We have to get everybody who’s a target for vaccine vaccinated, and we have to get enough people to give the vaccine.’’
The campaigns carry a substantial price tag: The federal government is purchasing the nation’s entire allotment of vaccine against swine flu, known scientifically as H1N1,and has given Massachusetts $10.4 million to defray costs associated with vaccination drives and testing.
Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, said she expects insurers to cover the costs of administering both types of flu vaccine in traditional settings, such as hospitals and physician offices. Her group is reviewing whether those expenses will be coveredwhen plan members get their shots at vaccination drives in schools, government clinics, and elsewhere.
The first truckloads of vaccine against seasonal flu are expected to rumble into Massachusetts later this month, and agencies such as the Boston Public Health Commission are developing major campaigns to persuade people to get shots and sprays that protect against the disease, which kills an average of 36,000 Americans each year. It is estimated that 90 percent of Massachusetts adults and children fall into categories recommended to receive seasonal flu vaccine.
“If we are successful, we will reduce the burden of illness around seasonal flu, which would keep people from overwhelming the doctors’ office and the hospitals with seasonal flu illness while we wait to be able to vaccinate the target populations for H1N1 influenza,’’ said Barbara Ferrer, executive director of the Boston health agency.
That vaccine should start arriving in October. Based on the experience so far with swine flu – it disproportionately struck the young – vaccination drives will target pregnant women, children, young adults, health care workers, and patients with respiratory and cardiovascular complications and other serious chronic health conditions. About half of Massachusetts residents are in these target groups. Because their immune systems are like blank slates, having never encountered this strain of H1N1, they will need two vaccinations, a few weeks apart.
Older adults will not be a major focus of swine flu campaigns. In Massachusetts, only 1 percent of confirmed cases of the disease have been in people 65 and older. Since it was detected in April, the virus has killed 10 people in Massachusetts, 436 nationwide.
The twin vaccination campaigns willpresent a daunting challenge for state and local public health agencies nationwide, faced with budgets sorely depleted during the recession.
“There’s a workforce issue, but there’s also a significant communication and education issue so that the public can clearly understand there’s a difference between the seasonal flu vaccine and then dose one and dose two of your H1N1 vaccine,’’ said Jim Blumenstock, an executive at the Association of State and Territorial Health Officials.
Hoping to bolster the army of health professionals capable of vaccinating patients, the state Public Health Council -an appointed body of doctors, consumer advocates, and policy specialists – voted unanimously yesterday to enlist medical workers not normally involved in flu immunization campaigns. That could add up to 21,000 volunteer dentists, pharmacists, and paramedics.
“If you have many people coming, you want more lanes open,’’ said Dr. Lauren Smith, medical director of the state health agency. “One of the ways we overcome barriers to immunization is to make it as easy as possible.’’
The president of the Massachusetts Dental Society, Dr. David Samuels, said it was logical to tap dentists,already adept at giving injections for root canals and other treatments.
A Massachusetts Hospital Association executivesaid her group supports the emergency regulation aiming to boost vaccination rates among health care workers. The rule would allow employees to decline vaccination.
“It’s a population we want to make sure gets immunized,’’ said Dr. Alan Woodward, a member of the Public Health Council. “We can’t afford to lose them to illness in the midst of a pandemic.’’
Stephen Smith can be reached at stsmith@globe.com.
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