The Snohomish Health District (SHD) in northwest Washington State successfully organized mass vaccination clinics (MVC) in October and November 2009, as its "central strategy to prevent the spread of infectious disease." In Snohomish County (pop. 704,000), a public-private partnership successfully vaccinated more than 25,000 people in two days of mass immunizations.
An advisory committee with representatives from the public and private sectors began its planning efforts in July 2009. Each MVC had a hospital or major clinic sponsor responsible for operating the MVC; SHD was responsible for promoting and distributing the vaccines. Written consent forms documented basic demographic information, eligibility, and type of vaccine administered. Public health staff observed each MVC.
Snohomish County Fire District One participated in the mass vaccination efforts to immunize the county's first responders. Stanwood-Camano Fire District partnered with other stakeholders in the community to sponsor an alternative vaccination delivery strategy: a drive-through vaccination clinic. Nine clinics were held on Oct. 24 (vaccinating 5,429 people) and ten on Oct. 31 (vaccinating 20,185 people); the drive-through clinic operated on both days. Vaccine resources were allocated depending upon the quantity available and the number of clients each site anticipated serving. All in all, more than 25,000 people were immunized on two days, with clinic through-put as high as 500 people an hour.
A call center was opened on weekdays and mass clinic days to improve customer service and client response time. Volunteers logged 1,168 hours while providing information and education to more than 2,100 callers. Additionally, Dr. Gary Goldbaum, SHD Health Officer and Director, and his staff regularly sent email and fax updates to healthcare providers, schools, and childcare centers.
Messages and information were also translated into languages other than English, and interpreters were available at the mass clinics. Even amateur radio operators joined in to share information between clinics and the unified coordination center (UC).
Outside the clinics, clients were directed into "airport-style" queues made from caution tape and barricades. Inside the clinics, planners used various colored forms, signs, and markers to clarify where to go and to improve traffic flow. For example, one clinic used various colored balloons to direct people to the appropriate lines for vaccine presentation.
Eligibility criteria for receiving the H1N1 vaccine was defined by the Centers for Disease Control and Prevention (CDC) and changed over time, depending upon vaccine availability. During the Snohomish clinics, the CDC advised public health agencies to restrict the vaccine to healthcare workers (HCW), pregnant women, persons caring for infants less than six months old, children and young adults ages six months to 24 years, and adults ages 25-64 with certain underlying health conditions. However, limited vaccine supplies required further restriction until more vaccine became available. Vaccinators had to target HCW, pregnant women, and children younger than five years old at the Oct. 24 clinics. SHD expanded eligibility to full CDC criteria for the Oct. 31 clinics.
Multiple vaccine presentations further complicated MVC operations, Goldbaum said. Vaccine without preservative was restricted to pregnant women and children, yet other groups requested preservative-free vaccine. Also, intranasal vaccine is only approved for non-pregnant persons ages 2-49 without underlying health conditions.
Despite the logistical challenges, the partnership between SHD, medical providers, regional governments, and civil society groups yielded favorable numbers. Goldbaum credits the mass vaccination clinics with reducing stress on providers and greatly increasing the number of people being immunized. Clinics could accommodate more people in two days than the provider community could otherwise accommodate over weeks, he said.