Public Health Service Responseto Influenza Vaccine Supply

Problems

Lance E. Rodewald, MD

Immunization Services Division

National Immunization Program

CDC

Scope of CDC Talk

• What we were worried about

• What was done

• What happened so far

• Programmatic lessons learned so far

Basic Chronology

Notificationof CDC

of possibleenforcement

actions

MMWRannouncing

delay, possibleshortage

ACIPrecommendations

fordelay

scenariopublished

Jan 1 Dec 31

What We Were Worried About

• Vaccine shortage– Each 1M doses to elderly translates to

• 900 deaths• 1,300 hospitalizations

– Estimates of supply not reassuring– Vaccine supply dependant on manufacturer– Primarily private sector distribution

• Targeting vaccine during shortage

What Was Done

• Communicate with partners– Federal agencies– Public health and private providers

• Guarantee production of more vaccine• Develop web site• Generate new knowledge• Create good practices material• Conduct media campaigns

Federal Contract for Influenza Vaccine Production

• 9 million doses of influenza vaccine– Doses would not have been made without contract– Availability: mid-December, 2000– Approximate prices

• $3 - public sector• $5 - private

• Public health priority on purchase– Purpose: implement ACIP targeting policy– Purchase by application only

• Reviewed, ranked, prioritized by algorithm• Application to Aventis

Vaccine Production Purchase Chronology

Notificationof CDC

of possibleenforcement

actions

MMWRannouncing

delay, possibleshortage

ACIPrecommendations

fordelay

scenariopublished

Fundscertifiedfor 9Mdoses

MMWR:web sitetakingorders

Vaccineships

CDC Web Site www.cdc.gov/nip

• Vaccine availability– Links providers with vaccine to those without– Information only – not a vending site

• Vaccine available from manufacturer or wholesaler• Links to states willing to redistribute

– Initially, no vaccine on the web site– More valuable as season progresses

• Information– ACIP / MMWR statements– Links to news, surveillance, etc.

• Helpful material for providers

New Knowledge

• Provider-based studies (U. Michigan)– Focus groups– Quantitative survey

• Public-targeted studies– Focus groups in urban areas

One-Page Brochures for Providers’ Use

• Flyers desirable, according to physicians• Messages developed through focus groups

– Barriers to vaccination– Motivators to get vaccinated

• Three brochures are being finalized– Who is at high risk?– Don’t delay getting vaccinated– Your vaccination also protects others

• Wide availability of brochures

Media Campaign

• Harrison Maldanado and Associates (HMA)• Target audience

– African-Americans– Hispanic Americans– General population

• Media: TV, radio, outdoor/transit ads• Material made available to all partners• Two-phase campaign

– Mid-November: high risk vaccination– Dec. – Jan.: It is not too late to get vaccinated

What Happened So Far

• Delay was as predicted by FDA• Media campaigns conducted on time• Total supply similar to last year

– Time-related vaccine shortage occurred• Variation in timing of order fulfillment• Many upset providers

– Vaccination campaigns delayed / cancelled– Spot vaccine price rose and fell

• CDC-procured 9M doses of vaccine– Available as scheduled– Did not sell well

Vaccine Production Purchase Chronology

Notificationof CDC

of possibleenforcement

actions

MMWRannouncing

delay, possibleshortage

ACIPrecommendations

fordelay

scenariopublished

Fundscertifiedfor 9Mdoses

MMWR:web sitetakingorders

Vaccineships

CDC-Procured Vaccine

• Safety-net vaccine• Orders of intent to purchase

– Would be prioritized by algorithm– Peak 4.5M doses

• Actual orders made– Purchaser could withdraw intent– Total so far: 1.5M doses– 16% of the 9M doses

Programmatic Lessons Learned So Far

• Vaccine supply is fragile• Vaccine must be available on time• Distribution is private

– Third-party distributors prominent– Early contracts with penalty clauses– Physician ordering behavior difficult to change– Limited ability to influence private market– Must engage private sector early

• Vaccine demand is time sensitive– Matching supply and demand challenging– Currently there is a vaccine surplus

Lessons Learned (2)

• Targeting vaccination requires – Change in behavior– State and local public health infrastructure

to target vaccination efforts– Private sector capabilities currently

unavailable

• Effective communications

We Were Fortunate Because

• Not an early influenza season– 4 of last 18 seasons (22%) peaked in Dec.– Time-sensitive shortage more impact

• Total supply available this year was similar to last year– Able to reassure that vaccine will arrive

• Not a pandemic year