Busing Kids to Vaccination Centers and H1N1 Coupon Systems

H1N1 vaccine centers across Quebec are using a coupon system to cut down on wait times and control the flow of traffic inside the clinics. Streamlining the process for vaccination has been widely praised by vaccine recipients interviewed in the early days of the ticket system, and Quebec's health officials subsequently boasted of having the most efficient delivery system for swine flu shots in Canada.

Use of paper tickets or bracelets with a fixed return time has resulted in elimination of huge line-ups. Where people originally waited seven hours or more outside, with no bathroom facilities or protection from the elements, line-ups have now been radically reduced. The typical experience in Montreal now seems to be a time of about one to two hours, including time for the vaccination and the 15 minute observation period after injection. Individuals and small families will generally go through the clinics more quickly; larger families like ours take slightly longer due to processing of paperwork and administration of the vaccines to the whole group together.

Management vs Response to Demand

A thought-provoking article about the use of the ticket system made reference to a CBC radio interview in which British politician Tony Benn criticized governments that cease to think of themselves as the representatives of a people, preferring instead to manage those who elected them. In a Boing Boing article this week, Cory Doctorow discusses how representation is usually preferable, but in the case of H1N1 vaccine distribution perhaps management might be just what the doctor ordered.

I might be inclined to agree with Doctorow, but then, I don't really see this as an example of the government managing the people. The Montreal Health Agency was given a mandate to open vaccination clinics and to distribute swine flu vaccine to residents who request it. While the agency has set priority lists and has developed an 8-step procedure for processing the necessary paperwork and ensuring the proper formula and dose are given to each person, this is managing a work stream or ensuring that traffic flows efficiently through the clinic. There are several check points to be sure that the safety of individuals receiving the vaccine is protected, but at every step the individual's right to be informed and to refuse the recommended intervention is respected.
The right to be informed and the right to consent or refuse care are cornerstones of our health care system.

Although I'm sure there are those who will say the "whole truth" about vaccines has not been told, I must say that with both seasonal flu vaccines I've received in past and with the H1N1 vaccine my family received over the weekend, the quantity and quality of information received at every step of the process was far superior to information I've received about other vaccines, and about past medical procedures that involved long-term medication or even exposure to radiation.

Busing School Children to Mass Vaccination Centers

That being said, I do have to ask whether the decisions made in Quebec about busing school children to mass vaccination centers is not an example of the kind of "management" that Benn would condemn.

The plan, which seems to have come up out of nowhere last week, requires school boards to bus children to mass vaccination sites. Boards would have preferred in-school vaccination for a number of reasons, not the least of which were concerns for student safety and psychological well being. The cost of transporting thousands of students across the province is also prohibitive. Regardless of whether it comes out of school operating budgets as feared or is reimbursed from an already strained health care budget, I resent the very idea of the unnecessary spending. I also find it difficult to swallow the line that great amounts of vaccine would be lost if nurses went to schools.

They are going to seniors residences, after all.

Parental Choice

After initial reactions to the busing plan, health officials affirmed that parents would retain the option to choose whether to take their children for vaccination outside of school hours, or to allow for the school to bus them to the vaccination clinic with their classmates. And of course, there are those parents who will opt not to allow their children to receive the swine flu shot. This is a choice that must also be respected, and there certainly is a concern that vaccination through the school will result in parents feeling pressured to vaccinate when they would not have chosen to do so normally.

Our family took advantage to the chance in priority groups, and we all went to be vaccinated together over the weekend. I held my children's hands when they worried getting their shots would hurt, and I scooped my youngest up in my arms when she cried. I wouldn't have had it any other way.

I hope other parents will opt to take their children to local vaccination sites outside of school hours, and that those parents who prefer not to vaccinate their children will make this choice known to schools, loud and clear. If there is little demand for schools to play a role in the vaccination of children, perhaps we can avoid a costly mess altogether.

Sources:

"Quebec boasts fastest vaccine system" CBC News

"Quebec solves H1N1 vaccination queues with Disneyland Fastpasses" Cory Doctorow (Boing Boing)

"Vaccination plan frustrates school boards" CBC News