# Presentation: 206512

## Planning for the 2005-2006 Influenza Season

**National Vaccine Advisory Committee**
**February 8, 2005**
**Washington, DC**
**Lance E. Rodewald, MD**
**Director, Immunization Services Division**
**National Immunization Program, CDC**

## Topics

**Lessons to apply**
**Steps being taken**
**Questions for discussion**

## Key Lessons from Previous Seasons

**Maximize available information**
**Plan for multiple contingencies**
**Plan around limitations**
**Recommendations**
**Delivery system**
**Plan with stakeholders**

## 2005-06 Influenza Season Planning Group

**Scope – next season; non-pandemic**
**Charge**
**Identify priority activities for CDC**
**Determine who will lead / produce the activity**
**Develop time line**
**Monitor completion**
**Comprehensive and strategic representation**
**Primary planning group for CDC**

## Scenarios as Basis of Plans

**Variables**
**Number of manufacturers**
**Vaccine type**
**Production projections**
**Licensure status**
**Scenario output**
**Timing, number, type of doses available**
**Rough probability of occurrence**

## Production Projection Monitoring

**Critically important activity**
**NVPO to lead monitoring with FDA and CDC**
**Sequential milestones drive projections and allow more efficient planning**
**Information must be actionable**

## Prioritization Recommendations for Influenza Vaccine

**Last season, priorities developed in an emergency ACIP session**
**Priorities were important and effective, but imperfect**
**Flexibility for local circumstances turned out to be crucial**
**Widespread desire to create prioritizations ahead of time**

## Prioritization Considerations and Process

**ACIP considering evidence for groups**
**Hospitalization rate**
**Mortality rate**
**Group size**
**Usual coverage achieved**
**Vaccine effectiveness**
**Studying multi-tiered approach**
**Emphasizing role for LAIV**
**Presentation for ACIP vote this week**
**Weighing publication options**

## Vaccine Pre-Booking

**Non-binding orders**
**Helps manufacturers determine their market size**
**Influences vaccine contracts, such as CDC’s contract**
**Has had problems with double booking in the past**

## Vaccine Distribution Policies

**Predominant strategy is partial orders to all customers**
**Advantage: more vaccination early**
**Was important last season**
**Timing and prioritization important**
**Manufacturers and distributors have their own policies**
**Tracking of distribution – role of information**

## Planning for IND Vaccine in Routine Program

**Challenges**
**IND not optimized for routine use**
**Need to use IRB**
**Need for Co-PIs to expand access**
**Insurance carriers experience limited**
**Public and provider acceptance unknown**
**Planning strengths**
**Example INDs to modify**
**Identification of many set-up problems**

## Contracting for Vaccine

**Estimations of need**
**Public / private balance of purchase**
**Stockpiling strategy**

## Monitor Antigen-Sparing Studies

**Several under study / review**
**Some can impact the coming season**
**Important to develop new knowledge needed for future years**

## Other Activities

**Communications**
**Antiviral medication**
**Infection control**
**Evaluation**
**Monitoring legislative endeavors**

## What Could Better Planning Improve?

**Contracting**
**Pre-book and distribution**
**IND vaccine use**
**Recommendations**
**Communication**

## Questions for Consideration (1)

**What influenza vaccine environmental changes would more effectively promote vaccine use?**
**What strategies should be used to ensure a safety net for influenza vaccine supply?**
**How can IND vaccine be used most effectively?**

## Questions for Consideration (2)

**What are the optimal roles for local / state / federal public health, and how can they be seamlessly integrated?**
**How can we enhance public health’s responsiveness to crises?**

## Extra slides

## Long-Term Considerations

**Solidifying vaccine financing**
**Increasing number of mfgs**
**Supporting effective public health immunization workforce**
**Pandemic influenza**