With demand for H1N1 swine flu vaccine far exceeding supply -- leaving many Utahns literally out in the cold -- local health departments are changing their tactics for distributing doses.

The Salt Lake Valley and Weber-Morgan health departments said Tuesday they will not hold more mass vaccination clinics until they receive large shipments, or about 20,000 doses in the case of Salt Lake. Weber-Morgan will wait for about 5,000 doses, and also plans a first-come, first-served appointment system.

In the meantime, the two departments will send their smaller vaccine shipments to private health care providers and community health clinics, in the hope that will help cut down on wait times.

Davis County, which will

wait for 2,000 doses before holding another mass clinic, and Utah County are adopting ticket systems to reduce their lines. Utahns have been clamoring for vaccinations around the state, showing up many hours before local health departments' doors open -- and in cases camping out overnight in the cold.

In Utah County, hopeful vaccine hunters started lining up at 2:30 a.m. for a Tuesday mass clinic. The line -- which included parents with small children in strollers -- snaked through the county's parking deck to provide those in the queue with shelter from the snow and rain.

Utah County Health Department director Joseph Miner stood in a light snowfall Tuesday, answering residents' questions about the shots' availability. The department's 6,000 doses -- its smallest shipment yet -- were all claimed, so Miner canceled a Thursday clinic.

In the future, Miner said, the county will hand out tickets with specific times, allowing residents to return for shots. "We're trying to figure out a good way to do this," he said.

Davis County has used tickets for its most recent mass clinics, giving a ticket to each person in line who qualifies for a vaccine, public information officer Bob Ballew said. Once all of the tickets have been distributed, those left in line are sent home. "We think it worked well," he said.

Lewis Garrett, director of the Davis County Health Department, said his staff could handle back-to-back mass vaccination clinics during the week. But production of the H1N1 vaccine has taken longer than expected and the shots and nasal spray are only trickling in, so when mass vaccination clinics do open, the department is inundated.

"The supply-chain problem is causing all kinds of difficulties for us," Garrett said.

Meanwhile, he is sending out smaller shipments to obstetricians' offices for pregnant women, and to hospital and EMS workers, who are among the departments' priority groups.

Due to the short supply, each of Utah's 12 local health districts is setting rules for who is eligible for vaccinations, following guidelines from the Centers for Disease Control and Prevention.

For future vaccinations, Weber-Morgan will set up a first-come, first-served appointment system, spokeswoman Lori Buttars said. Between 9 a.m. and 10 a.m. every morning, residents can call 801-399-7251 and reserve doses until they're gone. The process will start over every Monday.

"We had a lot of people standing outside and it's snowing," Buttars said. "So we knew we had to do something else. Right now we just have 1,000 doses here and there, and that [waiting in line for a dose] is not viable."

The Salt Lake Valley Health Department may hold walk-in clinics again at some point, but right now it is completely out of H1N1 -- and seasonal flu -- vaccines, spokeswoman Pam Davenport said.

Private providers in Salt Lake County did not immediately know how much vaccine they will receive from the department. At Murray Pediatrics, staff members said they had expected the department clinics to continue, and they did not have a plan for distributing H1N1 vaccine.

The Stephen D. Ratcliffe Clinic in Salt Lake City has some doses on hand, but staff members said the vaccine is reserved for their regular patients.

Intermountain Healthcare spokesman Daron Cowley said the organization will follow the CDC guidelines on priority groups, but none of its clinics currently has H1N1 vaccine.

And when they get it, he said, "the preference is that you work through your physician's office or through the county," for patients who don't already receive their primary care at an Intermountain clinic.

But he also noted Intermountain has a long history of working with every patient that walks through its clinic doors.

Tribune reporters Matthew D. LaPlante and Sheila R. McCann contributed to this story.

lrosetta@sltrib.com, dmeyers@sltrib.com