The Problem: Each year 36,000 people die from the flu. Only half of people age 50 to 64 get annual influenza vaccinations, as recommended by the Centers for Disease Control and Prevention.

The Proposal: With the 2008 presidential election year, polling places—which are situated in every U.S. neighborhood—are expected to be heavily visited by older voters during prime flu shot season. Vote & Vax presents an opportunity to marshal public health agencies to provide flu vaccinations to everyone, including populations not easily reached with preventive medicine.

This project follows and expands on a 2006 demonstration project by the grantee when 13,790 flu vaccinations were delivered by providers at 127 polling places in 14 states.

Grantee Perspective: To Doug Shenson, M.D., M.P.H., “Vote & Vax is a ‘twofer.’ You come to vote and your local public health provider is there to provide a service from which you will benefit.”

While the numbers—like the voting results—will not be in until Election Day, Shenson hopes to have Vote & Vax clinics in polling places in 30 states. According to a July/August 2008 article in the Journal of Public Health Management Practice, some 20 million vaccinations could be delivered if the Vote & Vax program was universally available.

To begin to accomplish that, SPARC (Sickness Prevention Achieved through Regional Collaboration), which Shenson founded 1995, will provide technical assistance to any organization that wants to set up a Vote & Vax clinic. The clinics will charge the same customary fee for a vaccination as they would at any community-based clinic such as those offered at a drugstore or church. Vaccination recipients need not vote—or even be registered to vote.

“We are working with a huge range of partners from local municipal health departments to nonprofit visiting nurse associations and for-profit companies supplementing the local health department staff so they can deploy large number of vaccinations,” Shenson says. “Our national partners are the leading public health organizations that have all gotten behind the initiative and have been alerting their membership.”

Shenson believes that the time has come for Vote & Vax; that people will appreciate the convenience of receiving vaccinations where they vote and election officials will see that it can be done efficiently and it need not impeded the flow at the polling place. “This year is an opportunity to turbo-charge a program from a small pilot activity into a normal public health practice,” he says.

Vote & Vax provides a central resource for community partners to launch their own Vote & Vax clinic. Via its Web site, providers can access a resource guide and a marketing toolkit, as well as seek technical assistance in solving local issues.

“We are cheerleader, supporter and advocates for this extremely powerful intervention in public health,” says Shenson. “It is not often that an innovation comes around in public health that doesn’t require a large number of resources, but that reframes the problem in a certain way that makes it possible to have a significant increase in the delivery of a preventive measure.”

Vote & Vax also is promoting the clinics to local public health departments as valuable preparation for a pandemic. “Here is an exercise that does good immediately but also gives public health an opportunity to be outside the health care setting, interacting with other public entities to efficiently serve a lot of people on a single day.”

The genesis for Vote & Vax came from a conversation Shenson, then an assistant professor in the Department of Epidemiology and Social Medicine at the Montefiore Medical Center/Albert Einstein College of Medicine, had in 1994 with Michael Alderman, M.D., chairman of the department. At that time, health care reform seemed fixated on medical delivery while ignoring the importance of preventive medicine. “We thought there was an opportunity and a need for change,” Shenson says.

Out of that, Shenson created SPARC to promote disease prevention and serve residents of the four counties at the junction of Connecticut, Massachusetts and New York. In 1997, SPARC received an RWJF grant under the Local Initiative Funding Partners Program (now called Local Funding Partners). SPARC received a grant for Vote & Vax in 2004 and again in 2006 to take it to a national activity.

Shenson has even more ideas for innovating preventive services. “Vote & Vax can serve as a platform for pneumococcal vaccinations, mammogram referrals, cancer screenings and any number of other services we have in our arsenal of tools as preventive medicine experts.”

“With less than one-third of adults over age 50 up-to-date with their preventive screenings and a system completely ill-suited to populationwide delivery of preventive services,” Shenson says, “Vote & Vax holds the potential to make a huge difference.”

RWJF Perspective: “This is a real opportunity to test whether a public health intervention can be done at places where people naturally gather,” says Jane Isaacs Lowe, Ph.D., senior program officer and team leader for the Vulnerable Populations Portfolio. She adds that it is a good example of “the connection between where we live, work, learn and play—which is where health happens.”

This election year presents both an unprecedented opportunity for public health, and some challenges. To safeguard the integrity of the project, every clinic must have the approval of their election board. “As you can imagine, this is the last thing on the minds of the people on the election boards. They are worried about the turnout and ongoing problems with voting machines,” says Lowe.

Based on the previous two demonstrations, in 2004 and 2006, “we know the providers were happy and the people able to get flu shots were happy,” she says. “This time we are trying to go from the pilot to the replication and demonstration across the country. If we get sites in rural America, in urban communities and suburban settings, we will have achieved our goal of offering a traditional public health intervention in a nontraditional place.”