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Pandemics and Health Equity: Lessons Learned From the H1N1 Response in Los Angeles County

Plough, Alonzo PhD, MPH; Bristow, Benjamin MD, MPH; Fielding, Jonathan MD, MPH; Caldwell, Stephanie MPH; Khan, Sinan MPH, MA

Journal of Public Health Management & Practice:
doi: 10.1097/PHH.0b013e3181ff2ad7
Invited Article

Background: Pandemic preparedness and response (as with all public health actions) occur within a social, cultural, and historical context of preexisting health disparities and, in some populations, underlying mistrust in government. Almost 200 000 people received H1N1 vaccine at 109 free, public mass vaccination clinics operated by the Los Angeles County Department of Public Health between October 23, 2009, and December 8, 2009. Wide racial/ethnic disparities in vaccination rates were observed with African Americans having the lowest rate followed by whites.

Methodology/Principal Findings: Demographic information, including race/ethnicity, was obtained for 163 087 of the Los Angeles County residents who received vaccine. This information was compared with estimates of the Los Angeles County population distribution by race/ethnicity. Rate ratios of vaccination were as follows: white, reference; African American, 0.5; Asian, 3.2; Hispanic, 1.5; Native American, 1.9; and Pacific Islander, 4.3.

Significance: Significant political challenges and media coverage focused on equity in vaccination access specifically in the African American population. An important challenge was community-level informal messaging that ran counter to the “official” messages. Finally, we present a partnership strategy, developed in response to the challenges, to improve outreach and build trust and engagement with African Americans in Los Angeles County.

In Brief

This study describes the Los Angeles County Department of Public Health pandemic strategy, plan, and results of vaccination efforts with respect to disparities in vaccine uptake specifically in the African American population.

Author Information

Los Angeles County Department of Public Health (Drs Plough, Bristow, and Fielding and Ms Caldwell and Mr Khan), School of Public Health, University of California, Los Angeles, California (Drs Bristow and Fielding); School of Public Health, University of Washington, Seattle, Washington (Dr Plough).

Correspondence: Alonzo Plough, PhD, MPH, Los Angeles County Department of Public Health, 600 Commonwealth Ave, Suite 600, Los Angeles, CA 90005 (

We are indebted to Dulmini Kodagoda, Brandon Dean, Dr Robert Kim-Farley, and Dr. Steven Teutsch for their assistance in the production of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.