By ALICIA CHANG
AP Science Writer
RIVERSIDE, Calif. - Marco Torres stood on a busy road and waved an oversized yellow arrow with an unconventional message for a street marketing campaign: "FREE TODAY: H1N1 Flu Shots for All."
Local health officials launched the human billboard campaign at a time when health departments around the country are going to great lengths to spread the word that swine flu vaccines are in abundant supply and available for free to anyone who wants one.
Their advertising tactics include horseback banners at rodeos and wristbands handed out at nightclubs. Maine officials set up a flu clinic at the high school basketball playoffs this week, while other health departments are giving patients shots at airports, malls and even a trade show.
The fact that clinics are practically begging people to get vaccinated is a dramatic shift from just a few months ago when people stood in long lines and waited - sometimes for hours - to get the scarce vaccine.
While the outbreak has waned, the virus is still circulating and authorities warn that another wave of infections could hit. The 2009 H1N1 flu strain was first identified in April and a second wave of infections followed in the fall. At least 15,000 people have died worldwide, according to the World Health Organization, most of those in the U.S.
Since October, some 126 million vaccine doses have been shipped to states, but only about 75 million Americans have been vaccinated. The federal government has spent $1.6 billion on swine flu vaccine production.
In the past, doctors and other providers were able to return unused doses to vaccine makers and get reimbursed. That's not the case this year since the government bought the vaccines and distributed them free to states. Federal health officials are working out a plan to deal with leftover doses, though some local health departments have said they planned to throw away expired ones.
"The efforts need to be made to encourage people to get vaccinated. It is still a serious disease," said Robert Pestronk, executive director of the National Association of County and City Health Officials.
Health officials in Riverside County, east of Los Angeles, noticed a drop in vaccine demand after lifting restrictions on who can get it. When it was in scarce supply, the vaccine was rationed to pregnant women, children and young adults, health care workers and people with health problems.
So health officials turned to a sign company to position twirlers outside clinics, borrowing an advertising tactic used by the construction industry during the housing boom to promote unsold homes in new subdivisions.
"Since we're a commuter-driven society, this was a good way to do it," said Riverside County health officer Dr. Eric Frykman.
The walking billboards were part of a broader two-week effort to bring awareness to the availability of vaccine that also included buying traditional newspaper and radio ads - at a cost of $25,000.
It seems to be working. Nurses in Riverside County vaccinated 399 people last week - triple from the week before when there were no sign twirlers. The health department attributed the increase mostly to the hired hands.
Concerned about lack of demand at its vaccination clinics, the Okaloosa County Health Department in Florida flocked to unconventional venues, doling out shots to hundreds attending the annual Snowbird expo and hanging out at local malls.
Health officials also printed 16,500 "FREE H1N1 SHOT" wristbands at a cost of $615 so that two popular nightclubs can hand them out to patrons.
"It was a way to reach the 20-somethings. We wanted to be where they were," said Dr. Karen Chapman, director of the Okaloosa County Health Department.
Though health officials don't know how many young people came in as a result of the promotion, the outreach allowed them to vaccinate people they wouldn't otherwise reach.
During the basketball playoffs in Maine, health officials set up a flu clinic off the court for players, coaches and spectators. Last month, the Colorado Department of Public Health and Environment took the vaccination message to a heavily attended stock show and rodeo.
They blitzed restrooms with ads. Horseback riders carried bilingual banners promoting vaccinations during the Mexican rodeo segment while an announcer drove home the point in English and Spanish.
It's too soon to know if the effort paid off. But with plentiful vaccine, health officials wanted to target large crowds and Hispanics.
"You don't want to waste vaccine so of course, you want people to know it's available," said health department spokeswoman Lori Maldonado. "The risk is still there. We're still in flu season."
Erik Gordon, a professor and analyst at University of Michigan's Ross School of Business, said vaccine fatigue is to be expected as fear of the virus dims.
"It's fairly common to have a rush of people waiting in lines to get something when they think, 'If I don't get this, I may die'," he said. "Then, when the danger passes and it's pretty much over, it's not unusual for the demand to fall off the cliff immediately."
As Torres twirled his sign while jamming to reggaeton music, Ana Gutierrez strolled into the Riverside Neighborhood Health Center on Wednesday for another appointment and decided to roll up her sleeve for the shot.
"I saw it and said, 'I'm getting it,"' said Gutierrez, who tried unsuccessfully to find the vaccine in the fall during the height of the shortage.
A steady steam of others followed - some lured by the sign and others who found out about the free vaccine through other means.
"Let's get these vaccines moving. Otherwise they expire and then you're stuck with thousands of vaccines and we don't want that," said assistant nurse manager Sandra Garcia.
Torres, who kept the arrow pointing at the clinic, wasn't interested: "I'm afraid of shots. Been afraid since I was a little kid."