Give it a shot, Muskegon!

All across the country flu-shot season is coming to a close, while flu season itself is just starting, heading to traditional peak in February. (Yes, there’s still time to getyour flu shot if you have missed it!)

In the US, millions of people get flu shots each year, but more than half of us remain unprotected.  The statistics are fuzzy, but people who are vaccinated clearly benefit dramatically, with reductions in flu and flu-like illnesses of 75 percent and more.  Over the last few years, the percentages of people vaccinated have gradually risen – from 44 to 59 percent of children (<17 years) from 2009/10 to 2013/14, and from 40 to 44 percent among adults (18+ years) over the same period. For those who are unprotected, the overall costs are high: In the US the flu season accounts for 200,000 hospitalizations and 41,000 premature deaths.   (You can read more at http://www.cdc.gov/flu/protect/keyfacts.htm#benefits.)

But what about the local implications? We’re hoping to find some answers – and keep some people healthy – in Greater Musekgon, MI, one of the five Way to Wellville communities.  The story begins with an offer from Walgreens: a thousand flu shots for each of our communities.  We at HICCup countered: How about focusing on one community to start? That way we believe the impact will be greater and the measurement of that impact more compelling.

The whole thesis behind Wellville is that impact is often a function of relative size or density, not of absolute numbers. Several thousand flu shots in a community of 80,000 is likely to have an impact, whereas one thousand will just add to the noise.

In Muskegon, a loose coalition of local heroes and outside supporters, led by 1 in 21 Coordinator Jamie Helsen, took up the challenge, in the first of a series of yearly campaigns to get more people vaccinated and ultimately to measure the impact. The headline is that we did not reach our goal this year, but we have a running start on next year.

This year’s trial run came together quickly, starting in July. The real challenge, the group quickly discovered, is not the cost; it’s motivating people to get their shots and making it convenient for them to do so.

So, cue Boo to the Flu! events, Mercy Health’s Mercy on Wheels traveling medical van, and other inducements to get out the word – and the needles – in Greater Muskegon. In total, flu shots were offered at six events located acrss the community, from Muskegon city center to the Muskegon Heights High School.

And whom should we thank? Well, for starters, Jamie Helsen, 1 in 21 Coordinator, who led the effort.  Walgreens provided and delivered flu shots in multiple locations. In addition to the van, Mercy contributed marketing and PR. FamilyWize and Garfield Group contributed marketing support and significant staff time. The Farmers’ Market was the site of the largest event (October 24), while Muskegon Community College held two events for a total of 158 vaccinations. ProofPilot (in which Esther Dyson has an investment) offered data collection software and staff time to interview participants – and non-participants.  Gwen Williams, formerly with Muskegon Public Health and now Director of Programs at Northwest Michigan Health Services. And the many volunteers who showed up from all around the area!

The team learned a lot – including the need to start earlier next year. They pulled together a remarkable effort under tough conditions, including stormy weather on the Farmer’s Market day and sheer shortage of time. It’s clear that people won’t show up to a flu shot event, but at least some of them will get a flu shot at an event that they are attending for some other purpose.  In terms of participations, the most successful event took place alongside the 12th Annual African-American Diabetes Conference (put on by Mercy Health at the Muskegon Heights High School); it produced 42 vaccinations among just 160 attendees – most of whom were uninsured and probably would not have gotten the shot otherwise.

But free is not enough. Most people can get their flu shots for free, one way or another, but that’s not enough to overcome suspicions and fears surrounding vaccinations. Education, role models (we’re trying to persuade Muskegon Heights Mayor Kim Sims to get her flu shot in public next season!!) and other inducements will help next year.  Signs were not as effective as active volunteers. “We had to go out and talk to people and persuade them,” reports Emily Masri who volunteered at the Farmers’ Market event.

Give it a shot, Muskegon!The numbers…and what we make of them

The initial input – 347 flu shots that might not otherwise have been administered – is small, but it compares respectably (about 1 percent) with the county total of about 44,000 flu shots delivered to the Muskegon population in recent years.

But that’s just the people who get vaccinated.   What’s the impact of all those flu shots on the community as a whole, not just on the individuals involved?  Is there some tipping point at which the number of flu shots will have more than a linear impact on the incidence of flu? In other words, will the flu shots not only reduce flu among the recipients, but visibly limit the spread to other people? We won’t really find that out until next year, because 1 percent of a fuzzy number is still under the threshold of statistical interest.

Another important factor is how many of those flu shots were incremental: How many of the flu shots simply replaced ones people would have had anyway, and how many were ones that would not otherwise have happened? Despite best efforts, this year we don’t really know.

Musk02And finally, what is the cost of a case of the flu? The numbers are very fluid, but the average per case of the flu is some combination of days of work lost (but by sick people and by the parents or caretakers of sick children), drugs and medical care (including hospital stays). There are also some few tragic premature deaths, especially among people already weakened by some other illness or chronic condition.
For next year, we hope to track the effect of this effort more effectively, starting with more data about the baselines: How many people were vaccinated in this year’s season and in last year’s? What numbers can we collect – and measure against – for overall absenteeism, hospital admissions for flu, school days missed?
In short, this story is just beginning.  It’s not just about flu shots – inputs – but about measurement, impact, expenditures now vs. savings later. And in the end, about helping people take the simple step that can help them remain healthy through flu season.

And it’s about a first-time initiative that we hope will have a small if unmeasurable impact this year.  But whatever it does, it will provide a baseline and an education to support a bigger, better effort next year.

A recent study estimated that in the United States, annual influenza epidemics result in approximately 600,000 life-years lost, 3 million hospitalized days, and 30 million out patient visits, resulting in medical costs of $10 billion annually. According to this study, lost earnings due to illness and loss of life amounted to over $15 billion annually and the total economic burden of annual influenza epidemics amounts to over $80 billion. Also, in the US the flu season usually accounts for 200,000 hospitalizations and 41,000 premature deaths. Flu Season 2005-2006: Questions & Answers MedicineNet. Retrieved 2010-02-09