A report to

May 20, 2011

Vast majority of children are vaccinated-only 0.6% receive no immunizations at all

Some immunizations are having even better results than anticipatedShingles even better than original testsInfluenza protects babies who’s mothers got immunized

Some immunizations are not meeting expectationsAll races and ethnicities start the HPV series but there are racial disparities

in completing the 3 dose seriesAfter 2-5 years protection against meningitis drops off-2nd dose now

recommended at age 16

VTrckS-Central distribution system now piloted with 4 health departments-future-bar codes, date and date of expiration-better decision-making, better safety tracking, managing shortages, meaningful use (incentive pay)

Great Expectations

Records Broken – 162 million doses distributed of seasonal flu vaccine

Rotavirus – 80% drop in the disease Outbreak – Pertussis in California – last time such high

rate-1947-13,845 cases2010-9,477

Economic Return on Investment-key points to address Federal budget concerns

Estimated Return on Investmentof Childhood Vaccines

For each birth cohort vaccinated against 13 diseases in accordance with the schedule for DTaP, Hib, IPV, MMR, hep B, Varicella, Hepatitis A, Pneumo-7, and Rotavirus vaccines:

42,000 lives are saved 20M cases of disease are prevented 13.6 billion dollars in direct costs are saved 68.9 billion dollars in direct plus indirect (societal) costs are saved For each dollar invested in these vaccinations, $10.20 is saved

Full Presentation on Tues Mar 29, Workshop D2, 11:30AMPreliminary results of updated analysis from Zhou et al, Arch of Ped and Adolesc Med 2005

www.cdc.gov/vaccines/conversations

Immunizations Globally

• The Meningitis Project - Africa– Vaccine produced in India– In 10 days 11 million people were vaccinated in

Burkina Faso (entire population)– As of today only 2 cases of Meningitis A in

unvaccinated adults

Immunizations Globally• Polio Eradication

– 1988 1,000 cases/day to now 1,000 cases/year– 2008 WHO developed a new strategy based on

lessons learned• Lesson 1 – Immunity gaps allow virus to persist in

smaller populations than originally thought• Lesson 2 – Immunity thresholds to stop Polio differ,

being higher in Asia than Africa• Lesson 3 – Very different to optimize balance of

monovalent and trivalent OPV• Lesson 4 – Routes of Polio virus spread and outbreaks

are predictable

Immunizations Globally• Update on Cholera Vaccines

– 1800’s Vaccine from Spain – no proof of effectiveness– 1960’s – 2 dose vaccine; high side effects; Dc’d in 2000– 1980’s – Live attenuated; No efficacy; Dc’d– Dukoral – 2 does in adults, 3 doses < 6 years of age; 1-6

weeks apart; Cold chain; Buffer required; Licensed in 61 countries (not U.S.); pre-qualified by WHO

– Shanchol – 2 doses 14 days apart; No buffer required; $21 per dose; Ages 1 year and up; Not WHO pre-qualified; Licensed in India

• Vaccines used in conjunction with prevention and control strategies where Cholera is endemic

Communicating in a Fast Moving World

• Moving away from Interpreting marketing and towards conversation marketing

• Monitor the Internet – Google alerts; Google reader; Technorati.com (blogs)

• When and how to respond– Monitor, watch, and listen– Respond quickly

• Be conversational & Be transparent

• To deliver a message you must know:– Who is the audience– What channel to get the message out– Who is the spokesperson

Communicating in a Fast Moving World

• Technology is great but you have to get the message right.– Be First– Be Right– Be Credible

• You can’t rely on your credibility you earned the other day, you have to keep earning it.

Telling the Story of Vaccine Preventable Diseases

• Book – Vaccine Preventable Diseases – The Forgotten Story– Updated 2010– 95% responded having parents change their minds

about immunizations• Shot by Shot - Shotbyshot.org

– Video based project– Story gallery with 90 stories organized by the

disease

Telling Our Story: Developing a Compelling Narrative about Immunization

• To be a person you have a story• Stories transfer wisdom• Stories define who we are• Most importantly the evoke emotion

1. Hero2. Villain3. Journey4. Surprise5. Message6. Awe-Inspiring Emotion

Adolescents

• School Vaccination Assessment– North Dakota – State law all doses administered to

individuals <18 years of age have to be entered into their state immunization registry

Pregnant & Postpartum WomenGood Ideas:

With physician’s recommendation uptake for seasonal flu is higher

Standing orders for Tdap in hospitals

Voucher for 1 other primary person named by mother – 84.9% got vaccinated

Immunize for seasonal flu at WIC clinics – monthly pregnancy visits, grew from 9.3% coverage to over 20%

The Future of ImmunizationsThings to consider: Seasonal vs. pandemic Pipeline Trajectory:

Discovery Target Identification Validation Preclinical

DevelopmentClinical

Development Licensure Production Delivery

The Future of Immunizations Live attenuated DNA vaccine – optimizing antigenic combinations Vector – means by which virus is delivered to cell???? Virus-like particle – particles of virus put into vectors Subunit/Peptide “Universal’ vaccine – Human B-cells generating antibodies to

vaccines and natural infections Novel adjuvants Move away from egg-based=cell-based production PCAST report Recombinant – get a platform that can be approved by FDA

then plug in antigens in lower concentrations - virus vector combined with influenza virus genes

The Future of Immunizations

The Future of ImmunizationsPromise of recombinant technologies for producing/improving

influenza vaccines

• Speed• Flexibility• Scale up• Downstream processing simplified.• Other aspects…stability, formulation. • Tailored approaches eg. Targeting cellular responses, target

groups, universal/broader protection.

Pharmacies

• 6.2 million got flu immunizations at Walgreens with stores in all 50 states – adolescent and adult

• Their targets: well-intentioned moms, prevention-focused seniors, existing Rx patients

• Goal in addition to giving immunizations – partner with healthcare provider, physician notification letter

• Promotional efforts – tried to instill urgency and pride “I got a flu shot for _____ (name), pre-sell – flu shot card, flu shot heroes website

• Free for employees 25% last year, 50% this year

• Pharmacies are within 3 miles of every American• Health Professional Shortage Areas (HPSA’s)– 26%

of American population live in these – approximately 80 million people – 2600 Walgreens in these areas serving approximately 43.8%

• Missouri has more than 50% of population living in HPSA’s

References

2011 National Immunization Conference: State of the Nation's Immunization, Anne Schuchat, MD, Rear Admiral, US Public Health Service Director, National Center for Immunization and Respiratory Diseases

From Epidemic to Elimination: Serogroup A Conjugate Meningococcal Vaccine for the Meningitis Belt, Nancy Messonnier, M.D., Chief, Meningitis and Vaccine Preventable Diseases Branch, 2011 National Immunization Conference, March 2011

Polio Eratication: Progress and Challenges, Bruce Aylward, MD, MPH, World Health Organization, 2011 National Immunization Conference, March 2011

Update on Cholera Vaccines, Eric Mintz, MD, MPH, National Immunization Conference, March 29, 2011

Health and Risk Communications, Norm Hartman, TMT worldwide, National Immunization Conference, March 2011

Selling Your Story: Inside and Out, Tim Church, WA State Department of Health, National Immunization Conference, March 2011.

Stories that Change Behavior, Bill Smith, EDD, PHD, makingchange4u@gmail.com. , 2011 National Immunization Conference, March 2011

References

Matching School Immunization Records to NDIIS Data, Abbi Pierce, MPH, BAS, Immunization Surveillance Coordinator, North Dakota Department of Health; Keith LoMurray, BA, in, Sociology

Influenza Vaccination Coverage Among Pregnant Women From the National 2009 H1N1 Flu Survey (NHFS), 2009-10 Influenza Season, Helen Ding, MD, MSPH, Epidemiologist, Chenega Government Consulting LLC, National Immunization Conference, March 2011

Lessons Learned In Implementing a Cocoon Program to Prevent Infant Pertussis at Four Kansas Hospitals, Elizabeth Lawlor, MS, Epidemiologist, Kansas Department of Health and Environment, National Immunization Conference, March 2011

New Influenza Vaccine Technologies, Michael Perdue, PhD, BARDA, U.S. Department of Health and Human Services, National Immunization Conference, March 2011

Novel Approaches to Influenza Vaccines: What’s Coming? Frederick Cassels, PhD, NIAID, NIH, US Department of Health and Human Services, National Immunization Conference, March 2011

Community Pharmacy Impact on Access to Immunization s for Health Professional Shortage Areas, Patricia Murphy, MPH, Senior Research Analyst, Walgreen Co; Ed Cohen, PharmD; Devonee Harshburger, MS, National Immunization Conference, March 2011