From http://www.msnbc.msn.com/id/33179695/ns/health-swine_flu/


Doctors swamped by swine flu vaccine fears
Many say they’re not prepared to handle push to immunize everyone
By Anemona Hartocollis

updated 12:21 p.m. MT, Mon., Oct . 5, 2009
The fear of swine flu is being compounded by new worries, this time among primary care doctors who say that they are already being swamped by calls from patients anxious to get the new vaccine, and that they are ill-prepared to cope with the nationwide drive to immunize everyone, particularly children and adults with chronic illness.
The federal Centers for Disease Control and Prevention is to begin releasing the first doses of vaccine to doctors across the country this week.
Many doctors, especially pediatricians, say that while they know little about the program, they have been deluged with questions.
At the same time, the pediatricians, many of whom have thousands of patients whom they typically see once or twice a year for checkups, are struggling to figure out how to administer a large number of doses quickly in small offices with limited manpower, while still dealing with other illnesses.
Some said they were considering hiring nurses just for the vaccinations and setting aside days when children would be vaccinated in alphabetical order.
'A nightmare'
At Westchester Pediatrics, an office with 6,000 to 8,000 families in Hartsdale, N.Y., exasperated doctors have added a new choice to the office answering machine: “If you have a question about the flu vaccine , please dial 6.” Pressing 6 produces a further message saying that the swine flu vaccine is not yet available, and to keep checking the CDC.gov Web site for updates.
For those who are not satisfied, a sign in the office waiting room counsels patience.
Kathryn Paterno, the office manager, summed up the situation as “a nightmare.”
“People want it,” Ms. Paterno said of the swine flu vaccine. “When they listen to news reports, they pick out bits and pieces — ‘swine flu, get it’ — but they don’t quite comprehend that we don’t have it yet, and we’re dealing with a quite affluent socioeconomic group here.”
When asked whether his office had received vaccine inquiries, Dr. Herbert Lazarus, a pediatrician on the Upper West Side, said only half-jokingly: “Do you think that’s accounting for two-thirds of our phone calls, or three-quarters?”
In Philadelphia, Dr. Shea Cronley of Advocare Society Hill Pediatrics said she was concerned that emergency rooms were starting to see a rise in flu cases, but she did not know when she would be getting her share of vaccine.
“We’re waiting,” she said.
The Centers for Disease Control has embarked on an extensive immunization drive with a goal of producing 195 million to 250 million doses of vaccine.
The vaccine is being distributed free to local jurisdictions, like city and state health departments, which are responsible for taking orders from doctors, hospitals, school systems and the like. Normally, doctors order vaccines directly from manufacturers.
As of Friday, 47 states or localities, including Alabama, Minnesota, Chicago, New York, Washington and the Virgin Islands, had put in orders for more than 1.3 million doses.
Actual delivery will lag behind the orders, however, adding to the confusion about when doctors would get their share. The New York City Department of Health and Mental Hygiene said Friday that it expected to get only 68,800 doses by early this week, and New York State expected 59,000.
Even the city’s public hospitals remained uncertain about the logistics. “We are prepared to provide access to the H1N1 vaccine, said Ana Marengo, a spokeswoman for the New York City Health and Hospitals Corporation, “and the piece of information still missing is knowing when it will be available and how much everyone will get.”
Comes down to local decisions
Kathleen Sebelius, secretary of Health and Human Services , acknowledged the concerns, but said it was up to local health departments to run interference between doctors, hospitals and the federal government.
"I’ve heard a lot about how much confusion there is about how to get the vaccine,” Ms. Sebelius said Friday.
“We’ll never, from the mother ship, give one national picture,” she added. “It’s going to be many, many local decisions. What we do need to know is — if that information isn’t getting across, then maybe we can do something about it.”
Many school districts, including New York’s, are making plans to immunize children at school. But in interviews over the last few days, doctors said they were confused about whether they were expected to vaccinate their patients, or whether schools would take the lead.
“That’s a critical issue, and I can’t find out,” said Dr. Max Van Gilder, a New York City pediatrician in an office with about 4,800 patients.
In the Chicago suburb of Evanston, Ill., Dr. Irwin Benuck, a pediatrician in a practice of 8,000 patients, said parents were flooding the office with questions about when the vaccine would be available. He has ordered the vaccine from the local health department, but he does not know when he will get it. He is telling families also to look to other sources, like schools and drugstores.
“We’ve heard nothing in terms of timetables,” he said.
Dr. Jane R. Zucker, assistant commissioner of New York City’s bureau of immunization, said that the city considered doctors to be the first line of defense, and the schools a backup for children who did not have private doctors.
She said that New York would be splitting its first shipment of vaccine (in the form of a nasal mist unsuitable for pregnant women and people with chronic health conditions) between health care workers, who are required by state law to be immunized, and doctors treating children.
She said the city expected to get the vaccine into its elementary schools by early November and was considering setting up weekend vaccination clinics for older children.