One Person, One Dose

Our ability to immunize large numbers of Americans quickly and effectively against the H1N1 virus may depend on an unlikely resource: our voting system. I do not mean our elected leaders, but our network of polling places. As we learned in last year’s presidential election, American polling sites can process more than 130 million people in a single day.

Last Nov. 4, my colleagues and I conducted a national test of the Robert Wood Johnson Foundation’s Vote and Vax initiative. We found we were able to deliver more than 21,000 flu shots in 42 states and the District of Columbia. We worked with local public health practitioners and cleared the program with election officials to make sure we didn’t violate any polling regulations. Vaccinations were available to people regardless of whether they voted, and both adults and children took advantage of the opportunity.

At the time, we didn’t realize that our work may have been a rehearsal for something much bigger. The H1N1 pandemic is already upon us. Widespread influenza activity is reported in 46 states. On Saturday, President Obama declared the outbreak a national emergency.

As millions of doses of H1N1 vaccine are shipped out, doctors’ offices may be overwhelmed. Polling places, until now largely overlooked, could be used for providing mass inoculations.

There are about 186,000 polling places in the United States, in schools, centers for the elderly, churches and fire stations in every community. Federal law requires that they be accessible to people with disabilities, many of whom may be particularly vulnerable to influenza.

Still, not all polling places conform to accessibility rules and would need to be modified to serve as vaccination sites. Nearly a third of them cannot accommodate people in wheelchairs, according to a recent report by the Government Accountability Office.

Public health officials must soon decide how and where to deploy health care personnel to administer the H1N1 vaccine. If the pandemic becomes more severe, they will need to deliver the vaccine to large numbers of people while avoiding crowds that would increase the risk of infection. Sites that are universally available and dispersed across all neighborhoods would be ideal.

To get polling places ready to serve as vaccination sites, local health departments would first need to make sure each site is accessible. Plans would need to be made, too, for the allocation, transportation and cold storage of vaccine. The Centers for Disease Control and Prevention could help let the public know about polling-place vaccination. Arrangements to use the various facilities should be made now. Individual communities could offer vaccinations when they have received an adequate supply of vaccine.

Providing widespread delivery of H1N1 vaccine is an enormous, looming challenge. Our polling places offer the best way to meet it.

Douglas Shenson, an associate clinical professor of epidemiology and public health at the Yale School of Medicine and the executive director of the nonprofit organization Sickness Prevention Achieved Through Regional Collaboration.