Many public health authorities used mass vaccination clinics to administer 2009 H1N1 vaccine. Although mass clinics are an efficient way to vaccinate large numbers of people, in the case of 2009 H1N1, there were also some challenges, particularly about the use of ACIP recommendations to prioritize vaccine for the target groups.
In most places, people were asked to self-assert their eligibility for priority vaccination; public health officials did not ask for verification of a person’s high-risk status. This meant people could “game the system” and receive vaccine even if they were not in the targeted groups. However, the positive aspect of self-identification of eligibility was that it was easier for those administering the clinics. “You have to rely on people being honest,” explained Plough of LA County. “You will vaccinate a few people who are not high risk, but you will get a number of people who are uninsured—marginalized, and advance some of your equity principles.” Some participants were fine with this risk, and others had mechanisms in place (e.g., questionnaires, people walking the line) to reduce the risk of vaccinating people who were not in the prioritized groups. However, this concern of eligibility may change in the face of a more severe pandemic or public health emergency, given an adequate amount of vaccine.