How Hawaii Fights the Flu: Pop-up Vaccination Clinics and State Agency Collaboration

States are using creative and collaborative methods to increase flu immunization rates after 185 children died from influenza during the 2017-2018 season — the highest toll reported since the 2009 flu pandemic. The health and economic toll of last season’s flu outbreak in children nationwide included more than 48,000 hospitalizations and 6.5 million medical visits.

Increasing flu vaccination rates, especially early in the season, can help reduce flu-related illness and complications, yet nearly 80 percent of children who died from the flu last season had not received the flu vaccine. Compared to this time last year, estimated flu vaccination rates for children are up, but a recent poll found that one-third of parents said their child was unlikely to receive the flu vaccination this year.

“School-located vaccination programs are evidence-based, best-practice strategies that reduce out-of-pocket costs, increase vaccination rates, and increase access to immunizations that reduce morbidity and mortality related to vaccine-preventable diseases.”

—Community Preventive Services Task Force

Hawaii has been fighting the flu and improving childhood vaccinations in innovative ways for nearly a decade, relying on close collaboration between state education and health agencies to operate “pop-up,” school-based vaccination clinics to protect children’s health.

Removing barriers to vaccine access can help increase vaccination rates. Medicaid covers the flu vaccine for all enrolled children, as recommended by the Advisory Committee on Immunization Practices, which removes a financial barrier. However, removing non-financial barriers to accessing the flu vaccine – such as inconvenience – can also help increase vaccination rates. The Community Preventive Services Task Force recommends providing vaccinations in schools and childcare settings to address this barrier.

Watch Hawaii’s Department of Health YouTube informational promotion of its Stop Flu at School here.

Despite having very few school-located health clinics, Hawaii operates a yearly “pop-up” influenza program called Stop Flu at School. The program provides free flu vaccinations to all elementary and middle-school children in participating schools and is the result of a partnership between its state departments of health and education and the private health insurance association. The voluntary program improves accessibility to the vaccination by providing it during the school day. The Stop Flu at School program is made possible by a blend of private insurer in-kind and monetary donations, state support, and several federal funding sources. Federal support comes from funds for pandemic flu preparedness, the Vaccines for Children program (VFC), which provides immunizations at no charge to physicians’ offices and public health clinics that are registered as VFC providers, and the Section 317 Immunization Program immunization program funds. The state health department serves as the VFC provider for the pop-up clinics which allows VFC eligible children to receive influenza vaccine through the Stop Flu at School program. Insurance status is tracked for program participants and documented on consent forms. Insurance status is used as a proxy for VFC program eligibility.

An evaluation of the program from 2007 to 2011 found that close to 50 percent of the target age group received the flu vaccine as a result of the program, and nearly one-third of students vaccinated were covered by Medicaid. Data that tracked influenza-like illness in Hawaii suggests there was less flu activity during the program’s first years (2007-2010), compared to previous years. State health officials also credit their experience operating the Stop Flu at School program with enabling them to effectively conduct emergency mass vaccinations during the H1N1 pandemic, which occurred in 2009.

Mobile or pop-up school-based vaccination clinics provide an effective vehicle to increase access to vaccinations and protect the health of children, and have the potential to reduce overall disease burden and costs.

As Hawaii demonstrates, these clinics require leadership and collaboration between state agencies and the private sector. Alabama provides another example of state leadership in this area – the governor recently issued a resolution urging all schools to participate in school-based immunization programs.

In addition to leadership and cross-agency partnerships, implementing mobile vaccination clinics also requires planning and resources. State officials will find videos, checklists, and other resources in this Mobile Immunizations Toolkit developed by Spokane Regional Health District, which shows how Spokane County in Washington State worked with health departments, schools, and health care providers to create school- and community-based mobile immunization clinics.