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Health officials keep quiet about vaccine supplies

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It should be a little easier to find H1N1 flu vaccine for the youngest Minnesotans this week. Most counties now have enough doses to begin offering very limited public vaccination clinics targeting kids age nine and younger.  

See a related report on county Web sites lacking information about the H1N1 vaccine.

For most parents, these will be the first openly publicized H1N1 clinics since supplies of the vaccine started trickling in to the state more than a month ago.

  But up to this point, the vaccine distribution process here has been shrouded in secrecy. Some Minnesota clinics have withheld information from the public about their vaccine supplies. And the state Health Department has deliberately kept quiet about which clinics and hospitals have received doses.   

Allina Hospitals and Clinics has been receiving H1N1 vaccine for five weeks, since about mid-October. But Lynn Berg, Allina's director of Risk and Safety, says her employer's Web site contained a message for most of the past month, stating that Allina was still waiting to receive its H1N1 vaccine. 

"It's not that we're withholding information," said Berg. "I think we just don't want to have a situation like Park Nicollet had."

"The public has to trust what's going on. The less they know, the more they think something sneaky is going on."

Berg says Allina didn't update its Web site when its vaccine first arrived, because it didn't want to risk being swamped with calls -- which is what happened a few weeks ago to Park Nicollet. 

The St. Louis Park-based health system received 120,000 calls in just a few hours after it publicized that it had the H1N1 vaccine. The calls jammed Park Nicollet's phones and made it impossible for sick patients to get through to the clinic.

Since Allina didn't receive much vaccine, especially the first two weeks, Berg says it made the most sense to quietly contact patients who were in high-priority groups directly. But if other patients called and asked about the vaccine, Berg says Allina admitted to having it.

"We tried to be as up front with people if they called ... if they called we would tell them," said Berg. "But just trying to be honest, and then trying to manage it, is not easy. And lots of people have their stories of why they think they should be getting it." 

The Minnesota Department of Health has encouraged clinics to be cautious about promoting their vaccine supplies publicly. In fact, as of today, the agency still refuses to publish a list of providers that have received the vaccine.  

Kris Ehresmann, director of infectious diseases, says she knows that's frustrating to residents. But she says the policy means that Minnesotans have been spared long waits in vaccine lines -- something that has happened in many other states, and would have likely happened here, too, given the Park Nicollet example.

"We've admittedly been fairly cautious about that. And I think if that situation hadn't happened, we might have been more open to posting names of clinics," said Ehresmann. "I think at this point, that experience causes us to have a fairly cautious approach." 

But if the Health Department's goal is to minimize inconvenience, medical ethicist Art Caplan says it's not working.

"Patients shouldn't have to -- and the public shouldn't have to -- prowl around, snooping and digging to find out where in Minnesota the distribution is of swine flu vaccine," said Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. 

Caplan says Minnesota has done a better job of getting H1N1 vaccine to priority groups than many other states. But he says it's not acceptable for the Health Department to withhold information from the public about where the vaccine can be found.

"The public has to trust what's going on. The less they know, the more they think something sneaky, secretive is going on, the harder it is to keep their trust," he said. "So I really think you've got to be as open as possible, as honest as possible." 

Caplan says being as honest as possible means telling all residents where the vaccine is located, but also informing them that they can't get the vaccine if they are not in any of the priority groups. 

Caplan says government should trust that most people can handle that information and will follow the recommendations.

But in this situation, infectious disease expert Michael Osterholm says that approach still might not have worked. 

Osterholm is director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He says the vaccine supply has been so limited that even the highest-risk priority groups are still too big to be dealt with efficiently.

"In retrospect, many of the people who are now involved with having made recommendations about who should get the vaccine recognize -- wouldn't it have been better if we had tried to basically pick a risk group and finish that off before we moved to another one. So let's say, for example, pregnant women or health care workers," he said.   

Osterholm admits even that idea would have encountered snags during this pandemic.  That's because many of the initial doses of H1N1 vaccine were in the form of a nasal spray, which cannot be used in pregnant women and people with other medical conditions. 

As for all of the secrecy in Minnesota surrounding the vaccine supply, Osterholm says he doesn't blame health officials or providers for withholding that information from the public. He says no one in the nation was prepared to deal with the enormous logistical problems that a trickle of vaccine created. 

"We are so fortunate to date that this virus hasn't been a 1918-like virus, with as much confusion, inability to respond with vaccines in a timely way, and just lack of understanding of what we're going to do," said Osterholm. "Imagine if this was a virus that was killing 2 to 3 percent of the population?"     For those who place a premium on transparency, there may not be much comfort in that thought.  If a worst-case pandemic were to develop, information on where to get the flu vaccine might be even harder to come by.