Indiana Challenged in Delivering H1N1 Vaccination Message

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EAST CHICAGO, Ind. - In 2009, Indiana launched an aggressive H1N1 vaccination campaign. By March, 2010, well over one million people had been inoculated, but how the state’s 39 lab-confirmed H1N1 deaths since June, 2009, breaks down by ethnic group are not publicly available data. The state’s decision not to report H1N1 deaths by race most likely undermined messaging about the importance of vaccinations in the African-American community, particularly in northwest Indiana. Clouding the picture of H1N1 fatalities is the state’s communicable disease law, which requires health practitioners to report specific diseases. Influenza is not one of them.

If Indiana data parallels other states, H1N1 deaths among African Americans and Latinos are disproportionately high, attributed to a greater prevalence of diseases like diabetes and asthma that weaken the immune system. The release to media of data by race could have emphasized the need for vaccinations among African Americans and eased their long-held suspicion of public health initiatives.

Demetrious Gibbs, an almost 20-year-veteran of the Gary City Health Department, said of his city’s African-American populace, “It was hard to get people to actually take the vaccine.” For those who did hear or read messages about H1N1, Gibbs said the response, he said, was, “’I’m not taking that.’ They’re very distrustful of taking that vaccine.”

Verlie Harris, station manager for WLTH-AM 1370, a talk radio format that reaches a largely African-American audience, said she had received only one public service announcement regarding H1N1 since the virulent flu strain was first detected in April 2009. The PSA’s content was general, and there was no follow-up PSA with a message crafted to African-American listeners.

Harris regards WLTH as a vital listening post for Gary and Hammond, respectively the fifth and sixth largest cities in the state, and for smaller communities within broadcast range, like East Chicago’s 30,000 residents. Her listeners and African Americans typically were predisposed to be skeptical of H1N1 vaccinations.

Almost 60 percent of East Chicago’s H1N1 vaccinations were given to Hispanics, 14 percent to African Americans, and 17 percent to whites, ratios that roughly mirror the city’s demographics. On total H1N1 fatalities, however, Kristen Garcia, a field crisis community coordinator for Indiana State Department of Health, said H1N1 may be a factor but not the primary cause of death as determined by a coroner.

Reporting influenza as a secondary cause leads to an undercount, though the disease likely had become the enabler of its victim’s ultimate killer, like pneumonia. But Garcia said Indiana officials are bound by confidentiality requirements under state law that governs communicable disease reporting. For fear of violating privacy rights, a health official may err on side of caution, deciding not to enter a victim’s cause of death into the public record, particularly, as in some H1N1 cases, if the coroner cites the disease as secondary.

Garcia was among several Indiana health policy experts who met with northwest Indiana’s ethnic media about H1N1 and how to promote greater awareness of health concerns. The East Chicago Department of Public and Environmental Health hosted the March discussion, moderated by New America Media’s executive director, Sandy Close.

In East Chicago, under the U.S. Department of Health and Human Services “Take the Lead Campaign,” local officials launched and are still conducting free vaccination clinics, with attention on children from six months old to young adults up to age 24, a cohort the CDC has identified as one of its five at-risk groups.

According to Diana Garcia Burns, a family nurse practitioner with the city, over 4,000 H1N1 vaccinations have been administered. She gave them all.
With budgets being slashed, small cities and towns are often overwhelmed by the scale of the response needed for potential pandemics. “It’s very difficult for us because we’re working with limited resources,” Burns said.

East Chicago and Gary are the two remaining cities in Indiana with their own health departments. The rest of the state’s populace is serviced county health agencies. When Hammond, East Chicago’s neighboring city of 78,000, closed its health department in 2008, Lake County continued to run a satellite office there but discontinued it in December 2009. The public then was told to use the Lake County health facilities in Crown Point, but regular and affordable public transportation to Crown Point from Hammond is unavailable. By car from Hammond, East Chicago is just a few minutes away, rather than an hour round-trip drive to Crown Point.

Anita Ard, East Chicago’s local public health coordinator, said Hammond residents frequent the free public clinics offered by her agency and make use of other services as well. “We don’t turn people away,” she said.

Ads and flyers in Spanish, coupled with word of mouth, have been useful in promoting the dangers of H1N1 in the region’s Latino community, but to overcome concerns, particularly among African Americans, WLTH’s Harris said Indiana should have included ethnic media in paid advertising buys.

“We never heard anything about media buys,” Harris said to Garcia and representatives from East Chicago’s and state’s health departments. “We never heard anything from you.”

Northwest Indiana falls under the huge media shadow of Chicago, ranking third in media market size after Los Angeles and New York. Thus, advertising costs are high and the money is usually spent on “mainstream” media. Garcia said the state could improve its ethnic media outreach by including specific criteria in the contracts it puts out to bid to media buyers.