In some states, prisoners beat out priority groups

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1 Scarcity of vaccine incites local anger In some states, prisoners beat out priority groups By Jeff McDonald Friday, November 20, 2009 at midnight Eduardo Contreras / Union-Tribune Coralynn McCoy, 4, with her parents, Sue and Bill McCoy, at home yesterday. Coralynn became very

2 sick while waiting to get vaccinated for H1N1. As soon as Spring Valley construction worker Bill McCoy heard the county had received the swine flu vaccine last month, he launched a phone campaign to find a dose for his 4-year-old daughter, Coralynn. He secured an appointment for this coming Monday. But a staffer from the public health clinic in El Cajon called this week to cancel because the vaccines ran out. I said, That sounds unfair, and she said, Well, that s the way it is. I m sorry, McCoy said. The McCoys are among a growing number of San Diego County residents upset that public health officials repeatedly urged people to get vaccinated, even though supplies have been sporadic. Not only that, thousands of doses across the country have been diverted to Wall Street executives, prisoners and illegal immigrants even as young people and pregnant women considered more vulnerable to swine flu go without. Because the United States is a World Health Organization member, millions of vaccine shots also are scheduled to be sent to developing countries that cannot produce their own doses against the virus, also known as H1N1. Kids should be first, said McCoy, who questioned the priorities. That would be a simple way of doing it. Experts say it is not unusual for people to get frightened and begin pointing fingers when there are significant shortages of things they need. Whenever someone s individual survival is threatened, they re generally going to think more about their own survival than people in the community they don t know, said John H. Evans, a professor of sociology at the University of California San Diego. It s what philosophers call lifeboat ethics. The federal Centers for Disease Control and Prevention has prioritized pregnant women, caregivers for infants, health care personnel, people 6 months through 24 years of age and adults with underlying conditions. The current goal is to reach and vaccinate people in the five priority groups, regardless of what they do for a living or in which institution they are based, spokesman Christopher Cox wrote by . It s a person s health status or condition that matters when it comes to protecting people from H1N1. However, it is expected that, as more vaccine supplies become available, there will eventually be enough 2009 H1N1 flu vaccine for anyone who chooses to get vaccinated.

3 Still, Sally Kloman, a diabetic from Lakeside who spent almost three hours in line at a county clinic to get a vaccination, said the distribution has been a total failure. It feels to me like there are needs being put ahead of citizens, Kloman said. The county issued an alert this week that its seven public clinics have run out of the vaccine. The county has distributed more than 440,000 doses in recent weeks, but the health centers now have just a few dozen doses each; they will be reserved for pregnant women. We re frustrated too, said Dr. Wilma Wooten, the county s public health officer. We re all waiting on the vaccine. The county has not received a major shipment since Oct. 30, although smaller amounts of the vaccine are being sent directly to independent clinics and doctors. Wooten said patients should contact their primary-care physicians for information about getting immunized. County officials on Wednesday announced the latest death from the flu strain, a 4-month-old girl with no underlying medical conditions. The death raised the number of San Diego County fatalities to 33. Production of the H1N1 vaccine has been delayed while manufacturers struggle with a slower-thanexpected development cycle. Individual doses must grow inside chicken eggs before they are fully developed and ready for use. The U.S. government expects to distribute 250 million doses this flu season, but the number of immunizations delivered so far has been less than 30 million. California has received 5.2 million vaccine doses, enough to vaccinate approximately one in eight residents. Meanwhile, some states and local public health officials gave the vaccine to prison inmates and firms such as Goldman Sachs and Citigroup. Health clinics held at workplaces and other institutions are a legitimate and very effective place to administer vaccine, wrote Cox, of the CDC. Prison officials in Texas, Colorado and other states opted to vaccinate some inmates because of the close quarters in which they live. A spokesman for California prisons said the department had not yet received any H1N1 vaccine. When it does, officials will immunize the most medically vulnerable prisoners ahead of others. San Diego County adopted a similar policy for its jails. Medical Director Dr. Earl Goldstein ordered 400 doses but has none yet.

4 We re in line with everybody else; I don t know when we re going to get them, Goldstein said. We have a pandemic plan, and part of that plan is the vaccination of select people with the H1N1 virus. County clinics also have been immunizing illegal immigrants who fall into high-risk categories, a practice that makes sense to health experts because the virus does not recognize borders or race. Thomas Novotny, a professor in the Graduate School of Public Health at San Diego State University, said the government had generally done well in raising awareness of H1N1 and distributing the vaccine. But, he said, It s very hard to understand how investment bankers could somehow get a priority shipment. Novotny said he hopes people do not lose confidence in the government s ability to respond to public health crises. The system generally works well every year, Novotny said. This is a special situation, and there s been some difficulty in trying to meet the needs of the population. This year, the CDC established a vaccine-distribution policy that allots doses based on the number of people who live in particular regions. In California, about 10,000 clinics, physician groups and others have qualified as vaccinators. About 715 are registered in San Diego County. The federal distribution contractor, McKesson Corp. of San Francisco, delivers doses to approved vaccinators based on CDC recommendations. Walter Carlin, a retired airline executive from Del Mar, said government officials at every level should help their constituents before providing vaccine to foreign countries and less vulnerable populations. We have to learn to take care of ourselves first, Carlin said. We can t continue to attempt to play physician and patrolman for the rest of the world. While awaiting inoculation, Coralynn McCoy got a fever that soared to 105 degrees. By the time her parents got her to a hospital, the symptoms had lasted more than 48 hours. There was little they could do but apply compresses and give her cool baths and repeated doses of ibuprofen and acetaminophen. Health care providers didn t even test to see if what she experienced was swine flu. The 4-year-old returned to preschool this week, but her father is still upset at the way the vaccines have been handled.

5 The first amounts they were promising us never came through, and the second amounts they were promising never came through, Bill McCoy said. Now we re on the third round, and I don t have much faith.