Many lessons are being learned as the swine influenza vaccination program plays out, and it’s only just begun.

The first is that when vaccines are in short supply — as are the H1N1 flu injectible and nasal-mist doses — it’s best to keep delivery tightly focused on the most vulnerable. Unfortunately many of them are stuck in long lines waiting to be inoculated against the novel flu strain.
The Centers for Disease Control and Prevention issued guidelines on which groups have priority — children, pregnant women, health-care providers and first responders among them — but left it to states to craft the specifics of the local distribution plans.
The distribution program suffered a black eye last week over news that New York health officials distributed large doses of the vaccine to Wall Street corporations and financial institutions that have in-house physicians. These financial institutions — hardly companies with the best public-relations standing just now — were stocked with vaccine doses while clinics and hospitals across the city turned people away.
The CDC since has since urged states to see that local vendors of the vaccine stick to the rules. “Any vaccine distribution decisions that appear to direct vaccine to people outside the identified priority groups have the potential to undermine the credibility of the program,” agency head Thomas R. Frieden said in a statement.
There’s no such egregious disconnect to report in Hawai'i, but still there’s room for improvement here as well.
The Department of Health set up its distribution web with the right intentions — allowing pharmacies to deliver some doses, making them more easily accessible to working people. Officials affirm that they’re spot-checking with pharmacies to make sure that only priority groups are getting doses.
But given the limited supply, vaccine doses are best directed to providers who can access patient records and more easily target priority groups. Once supplies increase, the state can resume its wide net and its spot checks.
To reconfigure its distribution, though, the department needs help from providers. At this point, too few of the clinics, doctors and pharmacies are reporting back with updates on how many doses went out and to whom. The state needs a clear picture on where the need is greatest for specific types of vaccine so the doses can be distributed most strategically to reach the vulnerable groups. Providers need to step up their efforts to give the health department current status reports.
The public also retains its critical role and responsibility, in that prevention is still the best defense. That means staying home, or keeping your children home, when flu symptoms appear; regular hand washing; and limiting your contact with others when you are sick. Even those who are vaccinated have to remain vigilant because the immunity takes up to two weeks to develop.
The swine flu already has dealt a tragic blow to too many families. The goal is to strengthen defenses against that disease, and vaccination is only part of the line of defense.
A large element of the protection depends on each of us.