When the stigmas of AIDS and HIV got the CDC’s attention in the 1990s, the agency rolled out a streamlined plan for preventing communicable diseases by using a single vaccine or easy-to-use medication, known as “active surveillance.” The idea was to engage city residents in routine immunizations — even those with health insurance — and keep the lists up to date to capture strains that aren’t kept in the bloodstream.
In Chicago, which has a relatively limited number of doctors and low rates of insured residents, this approach has been “brilliant,” says Dr. Wesley N. Bellamy, a professor at the University of Chicago Medical School and an expert on HIV.
But in 2014, the city became well aware that, unless it created a system that followed these basic guidelines, it would not be able to respond well to outbreaks. So it took advantage of a rare window of time. The Trump administration had put its eggheads to work on a proposal that shifted responsibility from the CDC to cities. The White House even held a presidential panel of national leaders to create a new plan for combating HIV and other infectious diseases, including new vaccines, by trusting local health departments to pick the best one.
Chicago then invested in the startup in a national pilot program, applying lessons learned in other cities as well. The pilot – dubbed “Community-to-Community Immunization” – tested the effectiveness of tailored plans.
This “one-stop” approach “was potentially the first real cluster-shot of vaccine history since measles-mumps-rubella,” says Gerard Gallucci, who headed the CDC’s HIV and AIDS branch and was one of the first people at the agency to think of integrated strategies for controlling epidemics.
Chicago has enjoyed “fewer, smaller outbreaks” since the cluster, which appeared after the city began adding the primary contender of vaccine into its approach: Cervarix. It is approved in many countries for use in adolescence and adolescent men, although the approval is still pending in the United States. But it is often unavailable.
Now, the city is running the pilot again: Cervarix is still being used, along with a booster called efavirenz, in addition to other kids’ vaccines. But it is barely being advertised as efavirenz, and so many patients don’t get it. To address that gap, the city has signed up 500 health workers as part of its Community to Community program.
It’s a sensitive program, already facing the chilly political winds from Donald Trump and his view of government programs as bureaucratic bloat. Still, it’s the model that the city hopes will help it cope with emerging threats like Zika, which city health officials say are most likely to hit Chicago residents in summer when mosquitoes are biting the most.
Now that he’s in office, Mr. Trump has yet to pay much attention to the community-to-community approach, which is still in pilot phase.
It’s vital to start making vaccine education a priority with our young people, said the newly minted health commissioner, Dr. Eden Wells. But, given the challenges of preparing a vaccine against a disease as unpredictable as Zika, it would be silly to make great strides with a piecemeal approach.
The city has accepted responsibility for vaccinating 750,000 residents by providing them with information and records of their vaccinations through a computer program to “greatly cut down on errors.”
Some of the program’s success is about money. Chicago spent $9 million last year on the incubator for the new CDC vaccine model — in a fight against an infection rate that is higher than the national average. The pilot plans for another $4 million may only add one new exchange in 2018 and is almost impossible for patients who use state clinics.