# Presentation: 142692

## Public Health Service Responseto 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

**Notification**
**of CDC**
**of possible**
**enforcement**
**actions**

**MMWR**
**announcing**
**delay, possible**
**shortage**

**ACIP**
**recommendations**
** ****for**
**delay**
**scenario**
**published**

**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

**Notification**
**of CDC**
**of possible**
**enforcement**
**actions**

**MMWR**
**announcing**
**delay, possible**
**shortage**

**ACIP**
**recommendations**
** ****for**
**delay**
**scenario**
**published**

**Funds**
**certified**
**for 9M**
**doses**

**MMWR:**
**web site**
**taking**
**orders**

**Vaccine**
**ships**

## 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

**Notification**
**of CDC**
**of possible**
**enforcement**
**actions**

**MMWR**
**announcing**
**delay, possible**
**shortage**

**ACIP**
**recommendations**
** ****for**
**delay**
**scenario**
**published**

**Funds**
**certified**
**for 9M**
**doses**

**MMWR:**
**web site**
**taking**
**orders**

**Vaccine**
**ships**

## 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