The Struggle for Efficiency and Equity: H1N1 Vaccine Distribution in Minnesota

Background: A major challenge in the H1N1 response was to create a system for efficient and equitable distribution of vaccine while supporting local differences in demand for vaccine and modes of local distribution. Minnesota is a geographically large state with 89 local health departments (LHDs). The LHDs represent cities and counties ranging from metropolitan centers with over a million residents to small counties with under 1,000 residents. Counties widely differ from one another in diversity, socioeconomic status, and the capacity of healthcare providers to respond to H1N1. The Minnesota Department of Health (MDH), in partnership with local public health (LPH), created and managed a distribution system at the state level while allowing for different local public health responses. Facilities wanting H1N1 vaccine needed to pre-register with MDH. Once vaccine was available, providers serving a population in the subset of the ACIP priority groups could pre-book for vaccine. MDH prioritized sites that provided care to children or pregnant women and randomized distribution within this group of providers. There was high demand for H1N1 vaccine and there was not sufficient vaccine to expand to the broader ACIP groups until late November. The pre-booking process was repeated in early December to include all pre-registered providers.

Setting: Minnesota

Population: All Minnesotans

Project Description: By analyzing of distribution data, surveys with LPH and providers, and data from Minnesota’s immunization registry, the Minnesota Department of Health will identify methods that worked well in distribution as well as possible areas for improvement.

Results/Lessons Learned: Clear communication with healthcare providers and the public was important throughout the H1N1 response. There are a many incorrect perceptions about disparities in vaccine distribution, so consistent, evidence-based methods of vaccine allocation are necessary to prove that the process was equitable. Many times rumors of inequity were dispelled by presenting distribution data.