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IN THE INTEREST OF TIME, I WILL SUMMARIZE MY STATEMENT.

WITH YOUR PERMISSION,

I WOULD LIKE TO HAVE THE ATTACHED SURVEY OF SELECTED COUNTY HEALTH AGENCIES BE MADE

PART OF THE HEARING RECORD. THE SURVEY WAS CONDUCTED TO DEMONSTRATE THE HIGH LEVEL
OF COUNTY INVOLVEMENT IN THE NATIONAL SWINE FLU PROGRAM.

I WOULD ALSO LIKE TO POINT OUT FOR THE RECORD THAT THE NATIONAL ASSOCIATION

OF COUNTY HEALTH OFFICIALS AND THE NATIONAL ASSOCIATION OF COUNTIES STRONGLY

SUPPORTED THE INITIAL DECISION TO LAUNCH THE VACCINATION PROGRAM AGAINST SWINE

INFLUENZA.

BOTH NACHO AND NACO PLEDGED THEIR SUPPORT AND COOPERATION IN CARRYING

OUR THE IMMUNIZATION PROGRAM.

WE DID WARN OUR COUNTY HEALTH OFFICERS ABOUT THE

POTENTIAL PROBLEMS THEY MIGET FACE

BASIC PROBLEMS LIKE STORAGE OF THE VACCINE,

LACK OF MANPOWER, CONFUSION OVER IMPLIED CONSENT, PUBLIC APATHY, AND MOST IMPORTANT

LY, THE LACK OF FINANCIAL RESOURCES TO GET THE JOB DONE.

FOR EXAMPLE, JEFFERSON

COUNTY, KENTUCKY SPENT $140,000 OF LOCAL MONEY THAT WAS NOT REIMBURSED; ARLINGTON

COUNTY, VIRGINIA SPENT $16,000; JEFFERSON COUNTY, ALABAMA SPENT $54,000; PALM

BEACH COUNTY, FLORIDA SPENT $30,000; GUILFORD COUNTY, NORTH CAROLINA SPENT $20,000.

MOST COUNTIES REPORTED THAT NON-REIMBURSABLE LOCAL FUNDS WERE SPENT ON PERSONNEL,

OVERTIME, PUBLIC RELATIONS, OUTREACH AND OTHER ADMINISTRATIVE COSTS.

THESE FUNDS

WERE LARGELY DIVERTED FROM OTHER BUDGETED PUBLIC HEALTH PRO

AMS.

IN RETROSPECT, WE STILL BELIEVE THOSE FEDERAL OFFICIALS RESPONSIBLE FOR

INITIATING THE PROGRAM ACTED IN GOOD FAITH.

WHAT CONCERNS US NOW IS THE LONG

RANGE NEGATIVE IMPACT THE SWINE FLU EPISODE WILL HAVE ON OTHER IMMUNIZATION

PROGRAMS CONDUCTED BY COUNTY HEALTH AGENCIES.

OF THE 52 MILLION AMERICAN CHILDREN

UNDER 15 YEARS OF AGE, 20 MILLION ARE NOT PROPERLY IMMUNIZED AGAINST POLIO, MEASLES,

RUBELLA, TETANUS, DIPHTHERIA AND WHOOPING COUGH.

WE HAVE THE VACCINES, THE PUBLIC

AND PRIVATE HEALTH CARE RESOURCES AND THE KNOW HOW TO IMMUNIZE THESE CHILDREN, YET

THE EXPERIENCE WITH THE SWINE FLU PROGRAM AND THE CURRENT IMMUNIZATION RATES

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REPRESENT A REAL DANGER OF OUTBREAKS OF THESE PREVENTABLE DISEASES.

THE COUNTY

HEALTH OFFICERS HAVE STRONGLY ENDORSED SECRETARY CALIFANO'S CHILD DISEASE IMMUNIZA

TION INITIATIVE.

WE WANT TO BE CONSULTED DURING INITIAL STAGES OF THE PROGRAM.

THE FEED-BACK FROM THE SWINE FLU EPISODE HIGHLIGHTS THE ESSENTIAL NEED TO INVOLVE

LOCAL HEALTH OFFICERS IN PROGRAM IMPLEMENTATION.

DURING THE SWINE FLU PROGRAM, THERE WAS A DEFINITE DRAIN ON LOCAL RESOURCES.

AS A RESULT, BASIC PUBLIC HEALTH IMMUNIZATION PROGRAMS SUFFERED FROM THE DIVERSION

OF MONEY, TIME AND MANPOWER TO THE NATIONAL INFLUENZA PROGRAM.

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FAILURE TO MAINTAIN PROPER IMMUNIZATION LEVELS CANNOT BE SOLELY BLAMED ON THE SWINE

FLU EPISODE.

IT IS A RESULT OF INAD EAQUATE KNOWLEDGE ON THE PART OF THE

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POPULATION, INSUFFICIENT CONCERN AND VIGILANCE ON THE PART OF THE PROFESSIONAL

COMMUNITY, THE FACT THAT DISEASE PREVENTION HAS TRADITIONALLY BEEN THE NEGLECTED

PART OF FEDERAL HEALTH CARE POLICY AND, FINALLY, THE LACK OF FEDERAL, STATE AND

LOCAL FUNDS TO IMPROVE THE CAPACITY OF LOCAL HEALTH AGENCIES TO CARRY OUT THEIR

PRIMARY MISSION

TO PROTECT THE PUBLIC'S HEALTH THROUGH DISEASE PREVENTION

ACTIVITIES.

WE CONCUR WITH THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS'

(ASTHO) CONCLUSIONS AND RECOMMENDATIONS CONCERNING THE NATIONAL INFLUENZA IMMUNIZA

TION PROGRAM.

OUR OWN RESEARCH FOUND THAT THE VERY NATURE OF THE EMERGENCY

IMMUNIZATION PROGRAM

CREATED PROBLEMS THAT WERE TO BE EXPECTED AND CONSTITUTED A

GREAT MAJORITY OF THE COMPLAINTS FROM THE COUNTIES.

THESE INCLUDED INSUFFICIENT

SUPPLIES OF VACCINE, TIME CONSUMING INFORMED CONSENT FORMS, CONSTANTLY CHANGING

GUIDELINES CREATING NUMEROUS ADMINISTRATIVE PROBLEMS, AMONG OTHERS.

BUT, MANY

BASIC ORGANIZATIONAL PROBLEMS COULD AND SHOULD BE AVOIDED IN ANY FUTURE MASS

IMMUNIZATION PROGRAM.

MORE MONEY ALLOCATED TOWARDS ADMINISTRATIVE ASPECTS OF THE

PROGRAM, PERSONNEL COSTS, FOR EXAMPLE, MORE COMMUNICATION (SOME COUNTY HEALTH

OFFICIALS FOUND OUT FROM THEIR LOCAL NEWSPAPERS WHEN THE PROGRAM WAS TO BEGIN),

AND DIRECT LOCAL HEALTH AGENCY INVOLVEMENT IN THE POLICYMAKING AND IMPLEMENTATION

PROCESS, WERE THE MOST OFTEN CITED SUGGESTIONS FOR IMPROVEMENT OF A NATIONAL

IMMUNIZATION PROGRAM.

OTHER SUGGESTIONS FROM OUR COUNTY HEALTH OFFICERS INCLUDE:

• INCREASED MEDIA SUPPORT FOR THE PROGRAM.

• HIGH PRIORITY PROJECTS SHOULD BE THE ONLY ONES CONSIDERED.

USE OF A TARGET POPULATION WOULD CUT DOWN ON CONFUSION AND INCREASE

EFFECTIVENESS.

INVOLVEMENT OF PRIVATE PHYSICIANS IN THE PROGRAM, AND INCLUDE THEM UNDER

THE LIABILITY COVERAGE.

LEAVE THE NORMAL DISTRIBUTION SYSTEM IN EFFECT IN ORDER TO AVOID TENSION

BETWEEN PUBLIC AND PRIVATE PROVIDERS.

.

BETTER ORGANIZATION AT THE FEDERAL LEVEL WOULD EASE IMPLEMENTATION AT

THE COUNTY LEVEL.

TIMELY DISTRIBUTION OF FUNDS AND VACCINES.

IDENTIFICATION OF PRIORITY GROUPS AMONG THE POPULATION AT RISK AND MORE

TECHNICAL ASSISTANCE TO DEVELOP EFFECTIVE STRATEGIES TO REACH INDIVIDUALS.

EFFECTIVE AND EXPEDITIOUS IMPLEMENTATION OF CONSENT FORMS AND PROCEDURES.

COORDINATION OF INFORMATION DISSEMINATION ACTIVITIES WITH OUTREACH AND

DELIVERY SERVICES.

• INVOLVEMENT OF ALL SEGMENTS OF THE COMMUNITY.

IN SUMMARY, MR. CHAIRMAN, THE NATIONAL SWINE FLU PROGRAM DEMONSTRATED THAT

STATE AND LOCAL HEALTH AGENCIES HAVE THE CAPABILITY TO RAPIDLY GEAR-UP TO CARRY

OUT A NATIONAL IMMUNIZATION PROGRAM.

ONE FINAL POINT NEEDS TO BE MADE.

LET IT

GO ON RECORD, MR. CHAIRMAN, THAT WHEN THE CALL WENT OUT TO PREPARE FOR A POSSIBLE

INFLUENZA EPIDEMIC IN THE SPRING OF 1976, COUNTY, STATE AND CITY PUBLIC HEALTH

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OFFICIALS, AT THE EXPENSE OF OTHER PUBLIC HEALTH ENDEAVORS, PERFORMED WITH DISTINC

TION.

THEY SHOULDERED THE BURDEN, THEY FACED THE CRITICAL PUBLIC AND THEIR LOCAL

GOVERNMENTS SUPPORTED THEIR IMMUNIZATION ACTIVITIES.

WE THANK YOU FOR GIVING US THE OPPORTUNITY TO SHARE OUR OBSERVATIONS CONCERN

ING COUNTY HEALTH AGENCY INVOLVEMENT IN THE NATIONAL INFLUENZA IMMUNIZATION PROGRAM.

THE NACHO SURVEY OF SELECTED COUNTY HEALTH DEPARTMENTS IS ATTACHED TO THIS

TESTIMONY.

THE DOCUMENTATION WILL NO DOUBT BE OF IMPORTANCE SINCE HEW IS

LAUNCHING A MASS IMMUNIZATION PROGRAM.

THANK YOU, MR. CHAIRMAN.

NACHO SURVEY OF SELECTED COUNTIES' EXPERIENCE WITH

THE NATIONAL INFLUENZA IMMUNIZATION PROGRAM*

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GUILFORD COUNTY, NORTH CAROLINA vaccinated 62,750 people (22% of its population).
Local money was spent mainly on overtime salaries ($20,000), but this has all been
reimbursed. The special clinics and non-routine operating hours created problems
in the beginning, but on the whole the program was viewed as "running smoothly."
The informed consent form was too time consuming, very bulky, and required addi-
tional staff. There was a necessity to stockpile the informed consent forms as
not enough were delivered at any one time. One suit was filed and turned over
to the county attorney, which was subsequently handled by the U.S. Public Health
service. A major fault with the swine flu program was the way publicity
was handled. This particular county noted that very few blacks were vaccinated,
and attributed this fact to the poor publicity.

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Although AUGUSTA COUNTY, VIRGINIA, like most other counties, leamed quickly how
to adapt to mass immunization procedures, there lingers deep resentment against
federal interference in what should have been a local program. The federal
government publicized certain aspects of the program that never materialized
at the local level (leading to certain embarrassment for county health officials
as implementers of the program). Edicts were sent out to local health officials
which complicated procedures rather than simplifying them. The county health
staff was completely tied up with administering the swine flu vaccine, which
set back many on going local prograsm (these constitute non-reimbursable costs
to the county). Administrative problems occurred with site location of immuni-
zation centers (traffic tie-ups at schools). The county still has a large
quantity of the vaccine and storing 1t is creating problems. The delay in
receiving the vaccine also created problems. More publicity and support from
the media was also suggested as a way to improve mass immunizations in the
future, This county vaccinated 25% of its population.

JEFFERSON COUNTY, ALABAMA (which includes the city of Birmingham) vaccinated
199,614 persons (47% of its total population). Approximately $54,000 of local
money was spent for supplies and wages that was not reimbursed by the state.
Delays in receiving the vaccine crected administrative problems. The informed
consent form created mechancial and logistical problems (major back ups in lines).
Jefferson County health officials feel not enough information about the program
was disseminated. Any future program should take more precautions and be of a
higher priority (unlike swine flu immunization turned out to be ) in order to
restore credibility in such programs. Using target populations was also suggested
as a means of averting many of the problems that occurred under swine flu program.

PALM BEACH COUNTY, FLORIDA vaccinated 114,000 people (32%) and spent approximately
$30,000 of local money that was not reimbursed. The program, as viewed from one
county health official,was cumbersome, but with much effort they made it a
workable program. A major problem was the inadequate funding for administration
(this is where almost all of the non-reimbursable local money was spent). Suggestions
for any future immunization project include more concrete planning, and involvement
of private and public physicians.

*Survey conducted in June 1977 by the National Association of County Health Officials, 1735 New York Avenue, N.W., Washington, D. C. 20006 (202) 785-9577

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