http://www.washingtonpost.com/wp-dyn/articles/A45663-2002Jan14.html

 

Operation Final Push
19,000 D.C. Students Must Be Vaccinated By Jan. 25. But How?

 

_____Resources_____

• Free Immunization Opportunities for Children in D.C. Schools (The Washington Post, Jan 15, 2002)

 


 


_____From The Post_____

• No Shots? No Class, District Schools Say (The Washington Post, Dec 4, 2001)

 


 


 

By Suz Redfearn
Special to The Washington Post
Tuesday, January 15, 2002; Page HE01

Nineteen thousand needles. 19,000 arms. 10 days.

That's the raw numerical challenge facing D.C. health officials, who have pledged to vaccinate all unimmunized D.C. public school students in that time. Come Friday, Jan. 25, the D.C. School Board says, any child who doesn't have proof of having had the necessary immunizations (and the annual tuberculosis test required of all D.C. school kids) will be "excluded" from school.

The vaccines, a battery of shots similar to those required by most school systems nationwide, are necessary to reduce health risk to individual students and prevent the spread of communicable diseases, officials say, including polio, tetanus, rubella, whooping cough, haemophilus influenza type b (the bacteria that can cause meningitis), chicken pox, mumps and hepatitis B.

To get all the kids stuck with the proper needles by the deadline, the school system has partnered with the D.C. Department of Health (DOH) in an extraordinary community effort, which as of today has taken on the name "Operation Final Push." They'll have to vaccinate kids at the rate of about 1,900 a day -- or 190 per hour in a 10-hour work day, every day -- to do it. The shots and paperwork -- multiple needles may be involved, depending on which vaccinations the child has had already -- take about 15 minutes per child to complete. All immunizations are administered in the upper arm.

District officials don't have precise demographics about the unimmunized children, but they know something about them. A majority are in high school, and four high schools in particular -- Wilson, Dunbar, Ballou and Eastern -- have unusually high numbers. At the beginning of the campaign, Pannell said, Wards 4 (east of Rock Creek Park to the border with Silver Spring, mostly in Northwest) and Ward 5 (around Catholic University, mostly in Northeast) each had 39 percent of kids out of compliance, the highest unvaccinated percentages among the city's wards. Assembling more detailed demographic information -- such as whether households where English is a second language are more affected -- "would require more data than we have even begun to build up," said Jack Pannell, deputy director of external affairs for the city health department.

A Grand Plan

With 10 days to go, Final Push is still in development. Pannell says he's tried to approach the task like an "advertising campaign." He hopes to line up radio stations to sponsor a contest where the school producing the most newly immunized kids wins. He wants a radio station to do live broadcasts from schools in Wards 4 and 5, local morning TV news programs to host DOH officials as the deadline nears and even a free movie ticket giveaway to kids who comply. None of these plans had been confirmed as of yesterday.

The District also needs to make the shots themselves easily available. The Department of Health has lined up more than two dozen locations (some served by mobile units) where vaccinations are offered at various times and days [see "Free Immunization Opportunities for Children in D.C. Schools" at right]. Some are in schools, some in clinics or other health care facilities. It has also arranged for mobile immunization vans to be parked near churches and shopping areas on weekends preceding Jan. 25. "We're still working to figure out where people are on Saturdays," Pannell said. When they do, "we'll be there."

Parents and kids are free to see their own doctors for the immunizations. The cost is typically that of the doctor's visit plus around $200 (private insurance usually pays a large portion, as does Medicaid). But the shots offered by the network of clinics, hospitals and service centers arranged by the DOH are free. Many have extended their hours to accommodate parents' work schedules.

Most clinics are participants in the D.C. Healthcare Alliance, a coalition of hospitals, agencies and insurers formed after the closing of D.C. General Hospital in order to deliver care to the poor and uninsured. The alliance, led by Greater Southeast Community Hospital, includes George Washington University Hospital, Children's Hospital, Unity Healthcare Inc., which oversees all community clinics in the District and D.C. Chartered Health Plan, a Medicaid HMO.

Getting clinics to agree to extend hours has not been a problem, but staffing and overtime issues loom. Some immunization providers have decided to bear the extra costs themselves. Joseph Wright, who's overseeing Children's Hospital's participation in the vaccination campaign, says Children's will pick up the tab for overtime at its clinics. (Children's is operating a vaccination clinic in the building formerly used by D.C. General; see box for details.) It will also pick up the tab for overtime by school nurses, all of whom are authorized to administer the vaccinations. (As part of its contract with the D.C. Healthcare Alliance, Children's functions as the employer of school nurses in the District.)

The community health clinics around town are already crowded, at least sporadically. The DOH's Division of Immunization clinic on Spring Road in Northwest Washington was teeming with kids and parents around lunch time on Jan. 7. DOH workers scrambled to process everyone. People filled about 20 chairs and another 10 stood leaning against walls in the hallway that served as a waiting room. When systems are operating smoothly, it takes no longer than 15 minutes to vaccinate and administer paperwork, but when crowds overwhelm staff, the wait can be long. (The following day the same clinic was nearly deserted when visited mid-day by our photographer).

Wright said the clinics under Children's Hospital's purview aren't jammed yet, but they have been getting four to five phone calls per hour. "This portends a lot of activity in the last week leading up to January 25," he said. He says the clinics have handled such volume before -- "though usually in the summer right before school starts."

Is This Really Necessary?

Some question the necessity of the mass-vaccination effort. Melvin Gerald, a family practitioner who has four offices in the District and one in Prince George's County, says he thinks about half of the 21,000 have already been immunized but don't have their paperwork to prove it. The zero-tolerance sweep through the school population "is not in the best interest of the children," Gerald said. (But Gerald, along with most others contacted for this report, does not believe re-vaccination, if it occurs, would be dangerous to most children).

When the federal government provided free vaccines to the District in the mid-90s, he said, kids flooded the clinics and some overwhelmed providers didn't do the paperwork correctly, failing to send copies to the city's Division of Immunization. To avoid such problems again, Gerald says, the city should set up a centralized database into which each clinic and practitioner could record immunizations. (Such a database exists, but it is not used by enough doctors or clinics to make it the single-source immunization list the city needs.)

Others worry that kids are being herded into clinics and immunized en masse, with no regard for their individual health records. Barbara Loe Fisher, president of the National Vaccine Information Center -- a non-profit watchdog group founded by parents who believe their children were harmed by vaccines -- says the District's campaign could pose a danger to children who might have bad reactions to vaccines.

"This needs to be individualized instead of putting people up against a wall like this," Fisher said. "Every child is not the same." She suggested the District give parents more time to take their kids to a primary care provider for vaccination. That way, a medical history could be taken, if the doctor doesn't have it already, and the child could be closely watched for any reactions.

Faced with inoculating kids with each vaccine required by D.C., many private doctors would opt to spread the shots over a few visits, said Joseph Wright of Children's, who is an emergency room physician. That's because of expected mild side effects like low-grade fever. But the District prefers to do it all in one sitting -- and with good reason, said Wright.

"If you've got a cohort of kids who are out of compliance, you take advantage of the opportunity to bring them into compliance when you can," Wright said. "That's public health common sense."

A Year in the Making

Despite the urgent, short-term nature of the campaign, parents of unimmunized children have had a year to get their kids' shots. In December 2000, D.C. Public Schools learned that 40,000 of the system's 68,500 students were not in compliance with immunization standards, according to Ralph Neal, assistant superintendent for D.C. schools. A task force was formed. A letter and a list of immunization clinics went out to parents of the 40,000 in January 2001. A reminder, also with a list, went out in May.

By October, said Neal, the number of unvaccinated children in school was down to 29,000. On Nov. 29, the task force committee voted to impose the drop-dead Jan. 25 deadline on the remaining kids -- 21,000 at that point. At a December meeting, the committee directed school Superintendent Paul L. Vance to wage a full-scale "media blitz," said Neal.

Letters were sent to clergy members, PTA presidents, Advisory Neighborhood Commission representatives and other community leaders, asking them to get the word out. Principals and school nurses were then notified. Parents were sent more letters. Memorandums of understanding were signed with health care providers. Each agreed to assist in establishing clinics and tracking down the parents of the elusive 21,000. By the new year, the number was down to 19,000. City officials did not have updated figures yesterday.

And now, with the message getting out and the clinics getting busier, Operation Final Push has just 10 days to go.

"This is not a school issue or a health department issue," said Neal. "This is a total community issue. All stakeholders need to rally round."

Suz Redfearn is a Washington-based freelance writer.

© 2002 The Washington Post Company


ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.