We’ve had great success with our current flu shot campaign, which includes walk-in clinics 7 days a week, as well as an off-site clinic at a local fall street festival and, of course, our "Boo to the Flu" event. The street fair and Halloween clinics are a lot of fun for our patients and providers alike. We hand out frisbees alongside the flu shots. We vaccinate established patients, documenting the immunizations on paper and entering them into the electronic medical record later.
We added Saturday and Sunday walk-in hours because we noticed our older students had a hard time making it in during the week. We also began offering to vaccinate parents and family members as a convenience at these events, as well as during appointments. Our reasoning is that one of best ways to protect a baby younger than 6 months old is to stop busy parents from bringing the flu home.
But all our creativity is hamstrung when we can’t guarantee equal access to the potentially life-saving vaccine. Flu vaccine is often delivered to pediatricians’ offices later than it’s delivered to corporate pharmacies. And flu vaccines that are part of the federal Vaccines For Children (VFC) Program – which offers free vaccines to about half of the children in America – are often delivered later than privately purchased flu vaccine. This is especially concerning given that many children who receive vaccines through the VFC Program are younger and more fragile.
The American Academy of Pediatrics (AAP) has been working with our national partners such as the Centers for Disease Control and Prevention and the Association of Immunization Managers for the past six years to minimize the delays in receiving VFC flu vaccines, but complex roadblocks remain.
"We’ve had great success with our current flu shot campaign, which includes walk-in clinics 7 days a week, as well as an off-site clinic at a local fall street festival and, of course, our ‘Boo to the Flu’ event."
Each year, the Centers for Disease Control & Prevention allocates VFC flu vaccine to each state immunization branch, which then has to decide how to distribute the vaccine. The yearly bolus of additional flu vaccine distribution work is difficult for the state branches when they are short staffed to begin with. There are so many decisions to make about who to ship to first. Alphabetical by practice name, or prioritized by practice size? How many doses can a practice store in their refrigerators? Will the practice accept any and all brands and presentation (multidose vial vs pre-filled syringe)? Will its providers begin to vaccinate in August, as CDC recommends, or do they want to wait until October? Some states allow practices to “borrow” from the privately purchased vaccine stocks until the VFC vaccine arrives; others don’t.
Our practice serves a community of children that is over half VFC-eligible. But even practices with only private flu vaccine can struggle, because arrival of a particular brand or presentation of flu vaccine may vary dramatically year to year. If you bet on the wrong company, your flu vaccine might show up late. We hedge our bets by ordering multiple presentations of the vaccine. Some practices even order from multiple companies.
The AAP and its member groups, including the Section on Administration and Practice Management, will continue to work on smoothing out the vaccine delivery process. Meanwhile, pediatricians can implement strategies to make flu vaccine as accessible as possible in their practice. Everyone practices in a unique environment, and what works well for one practice may not for another. For example, massive walk-in clinics only make sense if you have good parking and enough nursing staff, so you don’t end up with more patients in the waiting room than the fire marshal will allow!
I encourage you to try a new tactic each flu season and share what works best for your practice. It may or may not involve dressing up as a caped crusader before Halloween. But by giving patients the power of immunization to protect against the villainous flu virus, we’re all superheroes.
* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.
Diasio, MD, FAAP, was the Chair of SOAPM 2014-2018 and is currently the vice
president of the North Carolina Pediatric Society. He practices at Sandhills
Pediatrics in Southern Pines, Seven Lakes, and Raeford, NC.