Mall Clinics Provide H1N1 Vaccine to a Diverse Population

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Georgia's East Metro Health District (EMHD) – serving Gwinnett, Newton, and Rockdale Counties – developed creative strategies to address H1N1 vaccine shortages and better serve their community of approximately 1 million people.

An initial national shortage of H1N1 vaccine in fall 2009 required EMHD to limit vaccinations to CDC target groups and only offer vaccine in public health clinics. When EMHD received additional vaccine, it held a Saturday mass vaccination clinic in a local high school, and officials had to turn people away if they did not fit into one of the CDC target populations. In December 2009, the Georgia Department of Community Health announced that H1N1 vaccinations could be made available to the general public, and EMHD planned ways in which to quickly reach the local community with vaccine. Its goals were to meet heightened demand for the vaccine during the holiday season and bring vaccine to populations that might not normally visit a public health clinic

Promoting the Vaccine Clinics:
EMHD rented a 1,400 square foot store space in the Mall of Georgia and offered free H1N1 vaccinations to the public during mall hours over two weekends (December 12-13 and December 18-19, 2009). Offering vaccine clinics in the mall brought vaccine to large numbers of people shopping for the holidays and targeted diverse segments of the population. People were able to obtain nasal, injectable, and thimerosal-free H1N1 vaccines at the mall clinic. EMHD used CDC Public Health Emergency Response (PHER) funding to establish the clinics and support supplies, staffing, and space rental.

The Public Information Officer (PIO) created a press release and contacted television, newspaper, and online media in the Atlanta media market to promote messages about free vaccine for everyone at the mall clinics. EMHD also e-mailed the press release widely to maximize local word-of-mouth.

EMHD brought public attention to its store front in a variety of creative ways. Planners used large A-frame signs to advertise the clinic's location throughout the mall. The store front was marked with a large overhead sign and smaller A-frame signs reading: "FREE H1N1 VACCINATIONS HERE." Greeters explained to passersby that EMHD was offering various types of H1N1 vaccine and offered guidance on how to get into line.

EMHD also used a mascot – a staff member dressed as Panda McFlu – to draw attention to the clinic. Panda entertained children as they waited in line and provided comfort if children became upset. The mascot also walked around the mall to raise awareness about the vaccine clinic and direct shoppers to the store front.

Managing Vaccine Demand:
The mall clinics were organized to best meet the needs of people who wanted to receive a vaccine with little time or effort, and also to make people as comfortable as possible. Staff directed the line of people across the mall aisle and along a central railing, where nurses passed out consent forms and Vaccine Information Sheets. Consent forms were printed with English on one side and Spanish on the other, so everyone waiting in line received the same form. Support staff set up clipboards with the appropriate information before people arrived at the clinic. Making necessary documents available to people as they waited in line greatly increased the efficiency and throughput of the clinic.

Nurses and other staff members walked the line to answer questions about the vaccine and the consent forms. Staff also verified that the forms were filled out correctly and marked the forms to indicate insurance status. Although everyone could receive the vaccine free of charge, EMHD collected insurance information (if available) to bill for an administration fee. After reaching the front of the line, people with health insurance were guided to a station where insurance cards could be copied and attached to their consent forms.

Operating Vaccine Clinics:
Mall vaccine clinics consisted of six nursing stations that had capacity for up to two nurses. One of the stations had extra space to accommodate large families, wheelchairs, or baby strollers. Another station was surrounded by privacy screens, in case someone needed privacy to remove their shirt for the vaccination.

Clinic staff consisted of health department employees and Medical Reserve Corps volunteers, most of whom had participated in H1N1 mass vaccination clinics in the preceding weeks. When possible, at least two stations were staffed with Spanish-speaking nurses. Spanish-speakers were also present to assist with communication in the lines and at the insurance stations.

Vaccine supply and refrigeration status were monitored by a nurse and the EMHD logistics chief. Nurses were able to pre-draw vaccine at a specially designated station in the mall clinic. Runners brought clipboards to the line staff, refilled nursing supplies, and brought chilled vaccine to the nursing stations.

Staff either worked the full time that the mall was open (approximately twelve hours) or one of two six-hour shifts. Multiple changes were made rapidly due to bottlenecks or issues with the clinic organization and flow. Few staff were needed during the second weekend that the mall clinics were held, because some of the spontaneous changes made during the first weekend greatly increased efficiency.

Vaccine Clinics Outcome:
EMHD administered 5,900 vaccinations in two weekends using a total of around 25 staff people per shift. Wait times were always less than 15 minutes, even when the line was wrapped past multiple stores in the mall corridor, and many people expressed amazement at the quick and efficient process. The clinics were able to administer vaccine to approximately 250 people per hour due to their streamlined operations and motivated staff.

Due to the widespread media coverage, word-of-mouth, and use of a creative and convenient location, the mall clinics attracted people seeking vaccine from across the greater metropolitan Atlanta area. Many people were not aware of the vaccine clinic prior to coming to the mall but decided to be vaccinated due to the convenient location and low wait time. Even a couple from Florida visiting family for the weekend came to the vaccination clinic after hearing about it on the news. After the mall clinic's first day, many people came to be vaccinated at the encouragement of family or friends. Stores located near to the mall clinic also reported having the best day of the holiday season.

During the weeks following the mall clinics, public demand for vaccine and media coverage of H1N1-related issues decreased significantly. Subsequent clinics offered by EMHD resulted in a much smaller turnout compared to the mall vaccine clinics. Planners believed that the weekend mall clinics allowed EMHD to reach a large number of community members who may not have come to a health department clinic during the week. This strategy had the added benefit of providing exposure for EMHD to people who had never previously used public health services. This opportunity allowed EMHD to provide health district literature and increase awareness of public health clinic services and locations.

Holding H1N1 vaccination clinics at the Mall of Georgia demonstrated significant efficiency on the part of EMHD staff in carrying out a creative approach to meet community needs. Most importantly, it highlighted strong partnerships between EMHD, the media, and other partners in disseminating accurate health information to the community and surrounding areas in a timely manner.

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