always line up with the specific needs of individual health departments. “One size does not fit all when you are pushing money down for grants,” said Jackson of Georgetown, Texas. “Not every health department is the same.” Several participants urged the development of a simpler, more effective way to get money quickly when needed for an emergency response, while still retaining the necessary transparency and accountability.

State and local public health authorities were highly concerned, however, about how to sustain and capitalize on the infrastructure improvements, partnerships, and other capacities built, once federal funding for the emergency response was no longer available, particularly in light of the erosion of funding for public health infrastructure (NACCHO, 2010a; Trust for America’s Health, 2010).“How do you sustain the momentum and get people vaccinated, but do it in a system that you have been using all along?” asked Cooper of the Tennessee Department of Health.

Several participants said public health funding for emergency responses is a critical area for future work. As NACCHO’s Herrmann noted, “We can’t continue to rely on this big bolster of money [from the federal government] when an event happens in order to carry out our public health responsibilities and priorities. It is just a dangerous way to live, and we see that from event to event.”

Healthcare Providers and Pharmacies

Healthcare providers and pharmacies also encountered costs during the vaccination campaign, but unlike public health authorities, they did not have access to federal grant money. Costs associated with vaccine administration included staff time to administer the shots and the administrative activities associated with large-scale vaccinations: scheduling, data entry, and managing supplies. Pharmacies incurred costs transporting vaccine from a central location to their stores. Some, but not all, healthcare providers and pharmacies required copayment or administration fees to help cover these costs.

Challenges also arose with claiming reimbursement from insurers, especially during the initial months of the vaccination campaign. In the beginning no Current Procedural Terminology (CPT) codes were available for 2009 H1N1 vaccine administration. By the end of the event, two 2009 H1N1 codes were available: a CPT code and a Centers for Medi-

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