AAP Voices Blog

It was a beautiful October Saturday in North Carolina, and the office staff did a great job dressing up for Halloween to celebrate our annual "Say Boo to the Flu" walk-In flu clinic. The cast of costumed superheroes delighted children who might otherwise be unhappy about getting a shot—and parents who might otherwise have to wait for an appointment to get their child immunized.

After a brutal 2017-18 flu season, which claimed the lives of 185 U.S. children, families this year have been heeding the call to immunize all children 6 months and older. Whether through extended hours or festive walk-in events, we’ve been working to find ways to make it easier for families to do this. Adding multiple options and opportunities to get the flu vaccine has also helped us meet demand for the shots in a timely way.

We've tried several strategies over the past 15 years, including a massive "Get your flu shot this one weekend!” clinic, complete with high school students guiding families from a reception tent in the parking lot to the exam room where nurses waited with coolers of vaccine. Total time on site: <2 minutes. However, the event was costly relative to the number of doses of vaccines we delivered.

Another idea we tried was making it possible for families to sign up online for appointments, using software tools marketed for hairdressers. But it took a long time to transfer those appointments into the practice management system. We also discovered that patients’ expectations about a flu shot appointment led to some frustration. The same people who complained about waiting 5 minutes at a flu shot appointment thanked us for the walk-in flu shot convenience, even if they had to wait longer.

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.