The State of Michigan has 45 local health departments (LHD) servicing the state’s population of 10.08 million with many diverse services. One particularly important service these LHDs provide is immunizations.
LHD immunization clinics vary in size, from one staff person to maybe five or six full/part-time staff. Staff numbers may increase during busy seasons (e.g., back-to-school, and flu season), and during outbreaks. During the COVID-19 pandemic many of these LHDs were called into action to set up mobile clinics, drive thru vaccine clinics, and extended hours to meet the needs of their communities. LHDs played a crucial role during the pandemic, delivering a record number of adult COVID-19 vaccines and stepping up alongside pediatric offices to vaccinate children.
Immunization clinics offer many services to their communities with the goal of helping to prevent vaccine preventable diseases (VPD). The Vaccine for Children (VFC) program makes up a significant portion of the LHDs services. VFC is an entitlement program for children who are eligible to receive all the Advisory Committee on Immunization Practices (ACIP) recommended vaccines at no cost to children who might not otherwise be vaccinated. These immunizations are offered either through private VFC providers or LHD immunization clinics and are administered at no cost to children through 18 years of age who meet at least one of the following criteria: they are American Indian, Alaska Native, Medicaid-eligible, uninsured, or underinsured. Through the VFC program, LHDs have administered more than 27,000 immunizations already this year (see Fig. 1). They are administering four times as many VFC-funded doses as privately funded doses.
LHDs oversee providers in their jurisdiction who participate in the VFC program. Their oversight includes providing vaccine education and support (i.e., processing new and yearly VFC enrollments, authorization of VFC vaccine orders, answering billing questions, reviewing return/waste reports, guidance on vaccine storage and handling, and inventory support). It is also the responsibility of the LHD to ensure private VFC providers adhere to state and federal guidelines for this program. One such way is by conducting site visits at least every two years and following up on any questions or concerns that may arise during these visits.
In addition, LHDs also participate in state programs such as the Michigan Adult Vaccine Program (MI-AVP). This program helps to vaccinate adults 19 years and older who are uninsured or underinsured. Limited vaccines are available under this program, and the patient must meet the risk criteria for that vaccine to receive it. For more information about MI-AVP, call your LHD or go to Helping Adult Clients Pay for Vaccines (michigan.gov).
Furthermore, to ensure protection from vaccine preventable diseases, LHD immunization clinics also oversee local school districts and childcare centers in their jurisdiction to verify complete and accurate data entry into the Michigan Care Improvement Registry (MCIR) for state required vaccines. School districts must have 95 percent of their enrolled students up to date on school required immunizations to receive state funding. Not all parents/guardians decide to vaccinate their child(ren) with the school required immunizations. If they choose not to vaccinate, they must schedule and attend an educational session at their LHD to waive required immunizations. If there is a medical contraindication to vaccination, they may obtain a medical waiver from their family provider.
At present, the state of Michigan has several LHDs that provide travel clinics for those who travel outside of the United States. These travel clinics are by appointment only. Staff provides education and vaccine administration with the recommended and required immunizations for travel to different countries.
This article outlines only a small portion of what LHD immunization providers do for their communities. We all rely on LHDs to continue to provide vaccines and education to ensure protection for all Michiganders, especially for our underserved and vulnerable populations.
We want to thank all Michigan local health department immunization staff for their continued dedication and hard work.