and healthcare providers. As a result, private healthcare providers, healthcare systems, and public health authorities reported that they received high volumes of calls from anxious patients trying to locate vaccine for themselves or their family members.

The availability of multiple vaccine formulations with varying contraindications interacted with the use of priority groups to create complicated vaccine administration plans, which in turn had to be shared with the public. For example, if only LAIV was available at a given time in a certain location, only some members of target groups could be vaccinated there. This issue was particularly challenging for pediatricians because of the variations in ages for each formulation; this is discussed in more detail below.

With vaccine trickling out, there was a public perception in some jurisdictions that vaccine was being distributed unequally, even though it was taking place on a pro rata basis. For example, LA County has a population of about 10 million, while other counties, especially in northern California, are much smaller and therefore received many fewer doses of vaccine. Some people in the smaller counties thought that LA County was receiving a disproportionately larger share because it received such a large quantity of vaccine, despite the pro rata distribution scheme used. A similar perception occurred in Alaska because the majority of the population is centered around Anchorage. To counteract the perception, public health messaging began using the words, “your fair share” to emphasize that everyone was being treated equally. Participants emphasized the need to be honest and transparent about the situation when vaccine supplies were lower than demand.

Communication Among Public Health Authorities

Many mechanisms were used to help maintain communications among public health authorities at federal, state, tribal, territorial, and local levels, especially during the initial months when the situation, available information, and guidance were frequently changing. These mechanisms included regular conference calls with officials from the CDC, ASTHO, NACCHO, and the National Public Health Information Coalition. These efforts were intended to disseminate information from the federal level and to share practices at each level, to gather feedback regarding what was happening in the field, and to learn about different



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