Neuron Culture

I've wondered many times, including out loud in Slate, why it's not common in the U.S. to give flu vaccinations at schools, so they could efficiently be given to the population (children) whose inoculation most effectively prevents epidemics or pandemics, as well as to anyone else who wanted one. Same place, procedure, and personnel every year. It would simply and speed things immensely, and save scads of money?

This story in the Times has me asking the question anew. Instead of a single date (or a few dates) in which people can line up and get their shots in an orderly, efficient process, the entire primary care system is scrambling and overwhelmed -- and that's before either vaccine or shot arrives.

The federal Centers for Disease Control and Prevention released the first doses of vaccine on Monday. But many doctors, especially pediatricians, say they know little about the program and have been deluged with questions.

At the same time, the pediatricians are struggling to figure out how to administer perhaps thousands of doses quickly in small offices with limited staff, while still dealing with other illnesses.

Some said they were considering hiring nurses just for the vaccinations and setting aside days when children would be vaccinated in alphabetical order.

At Westchester Pediatrics, an office with 6,000 to 8,000 families in Hartsdale, N.Y., exasperated doctors have added a new choice to the office answering machine: "If you have a question about the flu vaccine, please dial 6." Pressing 6 produces a further message saying that the swine flu vaccine is not yet available, and to keep checking the CDC.gov Web site for updates.

For those who are not satisfied, a sign in the office waiting room counsels patience.

Kathryn Paterno, the office manager, summed up the situation as "a nightmare."

"People want it," Ms. Paterno said of the swine flu vaccine. "When they listen to news reports, they pick out bits and pieces -- 'swine flu, get it' -- but they don't quite comprehend that we don't have it yet, and we're dealing with a quite affluent socioeconomic group here."

When asked whether his office had received vaccine inquiries, Dr. Herbert Lazarus, a pediatrician on the Upper West Side, said only half-jokingly: "Do you think that's accounting for two-thirds of our phone calls, or three-quarters?"

In Philadelphia, Dr. Shea Cronley of Advocare Society Hill Pediatrics said she was concerned that emergency rooms were starting to see a rise in flu cases, but she did not know when she would be getting her share of vaccine.

"We're waiting," she said.