ALA'S locator spreads flu information: national collaboration tied efforts of many into one.

It was the widget heard 'round the world. Okay, around the nation. And it was seen, not heard, but you get the idea.

At its height in October, 2005, the American Lung Association's (ALA) online flu clinic directory, the Flu Clinic Locator, connected more than 30,000 public flu clinics around the nation, according to Todd Whitley, assistant vice president, online services, ALA in New York City. Some 20 local ALA offices and 70 outside agencies and health departments joined the alliance.

The 'Flu Clinic Locator' Web banner, or widget could be found on "literally millions of (Web) sites," said Whitley. It was a level of integration that had never before been achieved. "It was unbelievable."

The site (flucliniclocator.org) is closed until the 2006 flu season. Whitley said the national office is gearing up for what it anticipates will be another groundbreaking year for the site.

Beginning

The ALA has a long history of promoting educational resources regarding influenza (flu). But according to Michelle Sawatka, director, media relations, beginning in 2002 ALA broadened its endorsement of the flu vaccine. "We'd conducted a study through our asthma clinical research network and were able to prove that the flu vaccine was safe for people with asthma," said Sawatka. "That's when it became more of a mission for us."

During 2002, said Whitley, funders for the ALA-produced print publication, The Cold and Flu Guidelines, pulled their support. This prompted the organization to launch a more cost-effective Web site version of the popular publication. The publication is now receiving corporate funding.

The site proved enormously popular, said Whitley. To expand its efforts, the ALA in 2003 partnered with Maxim Health Systems, a division of Maxim Healthcare Services, headquartered in Columbia, Md., to provide the Web site's back-end technology and hosting services. According to Whitley, Maxim already had a robust site and a high volume (nearly 17,000) listing of public

"It was an exchange of services: Maxim would develop this for the ALA if the ALA would market it," said Whitley of the "gentleman's agreement" between the two organizations. "We married all of our best resources, where we didn't really have to put up any

Whitley was able to persuade 20 local ALA offices to join, posting thousands more clinics nationwide. "We understood we would be promoting (Maxim's) clinics, but the value of promoting our own (using their services) was seen as a greater need," said Whitley. Online consultant DonorDigital, with offices in San Francisco and Washington, D.C., encouraged the ALA to develop the 'Flu Clinic Locator' Web banner, a ZIP code search application that would allow online visitors to instantly find clinics in their area, he said.

The site offers features such as setting up a reminder about when a mobile clinic would be in the area, and a "send a friend" option that allows visitors to email clinic information.

During 2004, representatives at the Centers for Disease Control and Prevention (CDC) "turned to us in the midst of the (vaccine shortage in 2004) and said, 'You know, we really need you to help our (state) health departments more. And we really need you to have this site so that it's non-preferential,'" said Whitley. The site had been set up so that ALA clinics would appear first, followed by Maxim clinics, and so on. By the 2005 flu season, the ALA honored the CDC's request for impartiality, thus gaining the support of the Influenza Summit.

"It's actually surprising that the Influenza Summit ended up being as supportive as they were," said Whitley, of the coalition of more than 200 organizations, including manufacturers, distributors, public health agencies, clinic providers and the ALA. Several Summit members joined the effort, posting clinics and/or providing financial support, said Whitley.

Of course, not everybody was game. "With most multi-office national organizations, there's an 'us and them' mentality with the field," said Whitley. To his dismay, two localALA offices refused to join, satisfied with their own independent flu clinic locator sites.

The golden egg

According to Whitley, the success of the site is due largely to a unique feature, the Maxim-developed content management tool (CMT). Of the two dissenting ALA offices' sites, said Whitley, "there was no (CMT) for either. So in the last two years when the shortage occurred (and clinics began closing), they immediately had to close down their sites."

Per the CMT, the 90 participating organizations were required to sign a contract obligating they provide up-to-the-minute information about their clinics, said Whitley. "Maxim and (the ALA) were fixated on the fact that this was only going to work if people were truly dedicated to keeping this up to date. In doing so, we retained the trust and traffic from the public," he added.

In October, 2004, the public's trust was tested when the United States' supply of flu vaccine was cut nearly in hale as Britain shut down the world's second-leading supplier, Chiron Corp. According to a 2004 report broadcast on National Public Radio (NPR), the company had intended to ship 48 million doses of vaccine to the U.S., but regulators suspended the company's license, citing problems at its Liverpool, England, manufacturing plant.

Flu clinics across the nation subsequently shut their doors. To help quell the national unrest, said Whitley, the site was regularly updated. The ALA complemented this with its bimonthly Flu News e-newsletter, funded by Chiron, to further inform the public regarding vaccine and clinic availability. Subscriptions increased from about 20,000 during 2005 to 41,201 as of March, 2006, said Whitley.

Gross marketing

"Everyone understood the marketing," said Whitley. "We had a report from (2003) with, I don't know, it was some outrageous number, 12 million Web sites promoting the Flu (Clinic) Locator."

Entering into "friendly, in-kind" marketing partnerships, the only money the ALA put up was for the online push, said Whitley. During October and November, 2005, the ALA sent a series of outreach emails to more than 250 unique Web sites, including America Online (AOL), Microsoft Network (MSN), and WebMD, said Whitley. Response was nearly 100 percent positive, he added, with many groups posting on their sites either the new Uniform Resource Locator (URL), flucliniclocator.org, or the Web banner.

As of this past January, the new URL ranked on the first page (top 30 links) on Google for the call words "Flu Shot" and "Flu Shots," the first page on Yahoo! for "Flu Symptoms," and on the first page for MSN using "Influenza," according to a report by online service vendor Kintera provided by Whitley.

The site was promoted online by The Washington Post, The Chicago Sun-Times, Senior Journal, American Association of Retired Persons, Immunization Action Coalition and by the departments of health for New Mexico and Washington State, among other sites.

In addition to the online PR push, the site was promoted offline through two initiatives, one aimed at professionals, one at the general public, said Whitley. The offline promotion was funded through an unrestricted educational grant from Swiftwater, Penn.-based pharmaceutical company Sanofi Pasteur, he added.

Integration--one mind, one site

When the CDC approached the ALA during 2004, in addition to its request that the ALA create an impartial version of the site, the government agency requested help with changing a perception the American public has held for decades.

"It is ingrained in the American public to get their flu shot in October," said Whitley. With the right messaging, he said the hysteria that followed the vaccine shortage could have been avoided. "More (vaccine) became available in November, December and January," he said.

The site became a beacon, he said. "Essentially what we did was pay close attention to the changes that the CDC was announcing." Because of this fore sight and dedication, said Whitley, more than 1.5 million people were able to find clinic locations during October, 2004. During the 2005 flu season, more than 2 million visits were recorded.

"I've worked on a lot of campaign initiatives, and this was successful with partnerships, successful with the field, successful with the public, with online marketing. Integration was just successful overall," said Whitley. "That said, I failed to get some local lung associations (to join), and I struggle with that."

On the fundraising side, due to the popularity of the site and the Flu News e-newsletter, the ALA amassed 21,901 new email contacts during the second quarter of fiscal year 2006, more than six times the new contacts it acquired in the second quarter of FY2005. All other e-newsletters showed significant growth in the same time frame. The flu season "is right before our big (online appeal) effort," said Whitley. "All of the attention that we got really promoted a lot of subscribers to a lot of our e-newsletters and contact forms."

Although the site already offers instructions in Spanish and Chinese,Whitley said he would like to "see full-blown mirror or complementary campaigns going out to those audiences." On a more ambitious level, Whitley said he'd like to see the entire field of nonprofits in the "flu business" work together to clean up the Web and create one site.

"This is an opportunity for problem-solving with partners and coalitions in a different way," said Whitley. "This is a great template for how to look at disaster relief, very quickly. In terms of communications, data management, and internal and external needs for multiple groups, I think there's something to learn from this example."