Years ago, local officials had to hire police officers to control the crowds at municipal flu clinics, where there might be as many as 400 people trying to get shots during a typical, three-hour weekday session.
But law enforcement is no longer needed. Health directors in this area say more people now get their vaccinations at local pharmacies — and they lament the development because it means money is being siphoned from local coffers that they had been counting on for other health initiatives.
“I can’t compete with a 20 percent-off coupon” for shopping, said Sigalle Reiss, director of the Norwood Health Department, referring to a recent promotional offer by CVS.
Similar enticements have been offered by Target, Stop & Shop, Walgreen’s, and Rite Aid pharmacies.
Reiss said as many as 600 people used to show up for flu clinics in Norwood. This year a goal of 400 was set for a recent Saturday clinic, but 280 came. The town will continue to offer shots Tuesdays from 1 to 3 p.m. in the Town Hall, the first Monday evening of the month, or by appointment.
Reiss said it is good that people have more options for getting their flu shots. But she said that Norwood buys vaccines privately, in addition to a supply it receives from the state, and gets reimbursed for the private doses and for administering all the shots. That helps pay for other health measures, such as needle disposals.
Through Commonwealth Medicine, a partnership between the state and the UMass Medical School’s Center for Health Care Financing, municipalities have been able to get reimbursed for flu clinic efforts since 2009, when the H1N1 flu pandemic hit. Before that, health plans generally covered only the cost of administering the shots in a primary-care setting, and health departments had to absorb their costs.
This year, communities can be reimbursed an average of $18.23 for administering a privately purchased vaccine, and $15.78 for the state-supplied vaccine, according to Tom Lyons, a spokesman for the program. The reimbursements also vary depending on the type, from $10.20 per dose of intramuscular influenza to $27.40 for an enhanced high dose vaccine formulated for people 65 years and older.
Norwood spent $6,431 for 620 doses this year and expects to get reimbursed for recipients with insurance at about $40 per shot. After expenses are subtracted, an estimated $5,000 would be available for the needle disposal and other programs, Reiss said.
Reiss said it is important that communities continue to run flu clinics so uninsured people have access to the vaccine. Furthermore, she said, cities and towns need to be prepared in the event large amounts of a vaccine have to be administered quickly, such as in the case of the H1N1 outbreak.
“We need to maintain our relationships” with residents, “and the flu clinics are links to that,” she said.
Dedham Health Director Catherine Cardinale said she recently got a call from CVS asking how it might get into the Dedham schools to provide flu shots. She said her staff had been to the schools to provide shots to teachers, and she let the caller know that she preferred the company stay out of the schools. Leave that to us, was Cardinale’s reaction.
Cardinale said she has spent $4,000 for this fall’s doses and wants to make sure the supply gets used.
Asked about the town’s reaction to its outreach efforts, Mike DeAngelis, a spokesman for CVS, said the company is focused on the health care of its customers.
“We don’t really consider government agencies to be our competition; our goal is to work together,” he said.
He said when vaccines needed to be administered with the outbreak of the H1N1 virus, the government paid for the vaccines and turned to pharmacies to help administer the shots.
Also, he said, the Centers for Disease Control recommends that anyone older than 6 months get a flu shot. “The only way to reach that goal is to create more convenience and access,’’ he said. “Our pharmacies are open nights and weekends, and a lot of other practice settings are not.”
DeAngelis said there are 7,500 CVS stores in 42 states, 350 of them in Massachusetts.
He would not say how much the company makes on each flu shot. He said the cost to customers without insurance is $31.99, but he said the Affordable Health Care Act will cover such preventative care.
State epidemiologist Dr. Alfred DeMaria said that people can now get flu shots everywhere and that the loss of revenue is a problem for some communities.
But he is encouraging health departments to adjust.
“There are plenty of people who need flu shots,” he said. “Our goal is to get people immunized one way or another. We have to adapt to what’s happening.
“You have to be creative,’’ he said. “We don’t want to compete to get the people first, we want to get to the people who really need the shots.’’
Some communities, like Quincy, do not seek reimbursements for private vaccine purchases, only for administering the shots, and a city official said he was not opposed to the increase in the number of places for people to get vaccinated.
“It’s a different way of doing things, which is a good thing,” said Andrew Scheele, the city’s public health commissioner. He said the more options people have, the better.
The city budgets $5,000 a year to cover the cost of the flu clinics, he said. “It’s not about the money; it’s about making sure people get their flu shots.”
Danielle Brandon, the administrative assistant for the Board of Health in Duxbury, was helping out at the town’s recent flu clinic but opted to get her flu shot later at a pharmacy up the street from her home in Plymouth. She said she wanted to make sure there was enough vaccine for those who came to the clinic, since it usually runs out. This year, though, 73 people came for shots, leaving 27 doses unused.
For communities that lay out money for private supplies of vaccine, any leftover doses mean a loss of money and perhaps a curtailing of programs.
Norwood returned some of the supply it received from the state, and Reiss said her department is doing more outreach to use up the rest.
Cardinale said she misses the days of overflowing crowds at the town flu clinic.
“I would love to see those numbers back again,’’ she said.
Jean Lang can be reached at firstname.lastname@example.org