While it is important in such widespread and far-reaching networks to ensure that individual elements within the network are empowered to make decisions as they see fit, it is even more important that each node in the network is given access to all relevant information in a current and comprehensive manner (Porche, 2004). A plan needs to be in place for dealing with these health issues that takes the potentials of each entity's position in the public healthcare network into account, such that there is greater consistency and efficiency in the decisions made by each of these individual entities (Porche, 2004). If all counties or health districts/departments had similarly understood the potentials of the mist-form vaccine, as one key example, the vaccine shortages for the population at large would not have been as severe even though certain high priority could not have utilized this vaccine (Giles & Howitt, 2011). Furthermore, beyond simply having a better plan and hierarchy in place for the dissemination of information during such an epidemic, there needs to be a better and more strictly defined hierarchy of communication and distribution in general, as this is the only way to effectively facilitate the implementation of better communication during emergencies or other similarly extreme situations (Porche, 2004).
While the pre-existence of other resources, from an H1N1 vaccine to a better system of communication amongst Tennessee public health agencies and entities, would have helped to ease the situation presented in this case, there were also choices that could have been made to more effectively address the problem even with the resources that actually existed. Dr. Cooper's decision to let the Tennessee Emergency Management Administration (TEMA) stand down certainly seemed reasonable at the time, but without a real system of controls in place it was unwise to undue this centralized and more directly responsive entity's position in the fight to limit the spread and impact of H1N1 (Porche, 2004; Giles & Howitt, 2011). Allowing the TEMA force to stay in place as a key entity in coordinating the dispersal of information and of the vaccine itself could have perhaps alleviated much of the imbalance that was observed in the use of vaccines and could also have helped reassure the public that there was true attention being paid and applied in a consistent manner across the state's counties and regions. While it cannot be said from the details given in the case that TEMA's ongoing involvement would certainly have made a difference, it is certain that a lack of real central control and involvement contributed to the problems observed in the case, and TEMA might have provided the centrality and the accessibility that was truly needed (Porche, 2004).
Better communication also could have been achieved with the public at large. The lack of desire for vaccines by the time they were made available was largely due to inadequate public awareness regarding the vaccine's efficacy and safety, and there are many ways that even a very loose network or hierarchy of communication could have reached the public's ears (Gilbert et al., 2010). Much of the public also seemed uninformed when it came to what the impacts on their communities might and should be when cases of the flu began to appear, and though this was in part due to changing recommendations in the early days of the epidemic these changes were also not communicated clearly or with the speed that would have been desired (Porche, 2004; CDC, 2010; Giles & Howitt, 2011). Simply providing better and more complete information to the public would have alleviated many of the health-based problems even if the communication issues would not have been addressed.
Extensive and efficient communication is always difficult in any large network. When this network is comprise of many independent entities it becomes all the more difficult. In issues of public health, however, it is necessary to have the foresight and the effort to address these problems proactively.
CDC. (2010). 2009 H1N1 Flu. Accessed 15 October 2012. http://www.cdc.gov/h1n1flu/
Gilbert, G., Sawyer, R. & McNeill, E. (2010). Health Education. Sudbury, MA: Jones and Bartlett.
Porche, D. (2004). Public and Community Health. Thousand Oaks, CA: Sage.