Challenges in 2009 H1N1 influenza pandemic mass vaccination clinic deployment: Lessons from the city of Milwaukee health department experience

One of the most challenging aspects in the response to the 2009 H1N1 influenza pandemic by local public health agencies (LPHAs) was the implementation of a community-wide vaccination campaign. Mass immunization of this scope and duration has not been undertaken by LPHAs for decades and planning efforts were complicated by multiple factors including rapidly changing information including school closure criteria and uncertainty of vaccine production and delivery timelines. These types of challenges hindered LPHA response and created public skepticism around vaccine safety, efficacy as well as disease severity. The MHD conducted 16 large scale public vaccination clinics between late October and mid December 2009 after recording over 3200 confirmed and probable cases of infection in the City during the preceding spring. These clinics resulted in the administration of over 25,000 doses of vaccine. This unprecedented undertaking required flexible and adaptable clinic operational model to meet public demand for vaccine that was significantly influenced by media coverage and often conflicting information regarding vaccine prioritization and availability within the community. LPHA preparedness plans must be recalibrated based on lessons learned from the H1N1 pandemic experience and should address best practices in areas of incident command, sustainment of long-term surges in staffing, improved communication models to better manage public expectations and most importantly, institutionalizing key lessons learned from this event. Furthermore, LPHAs should consider aligning H1N1 vaccination strategies with medical countermeasure planning contained within other preparedness initiatives such as the Cities Readiness Initiative, Urban Area Security Initiative, BioWatch and CDC Bioterrorism Preparedness programs.