# Presentation: 080934

## Pandemic Influenza PreparednessUS Department of Veterans Affairs 

**Victoria Davey, RN, MPH**
- Deputy Chief, Public Health
- Department of Veterans Affairs

**National Vaccine Advisory Committee**
**Pandemic Influenza Working Group Meeting**
**April 19, 2005**

## Missions of the Veterans Health Administration 

-  Health care
-  Education of providers
-  Research
-  Emergency preparedness
- Pandemic flu preparedness relates
- to all VHA missions

## VA Medical Care

- 158 hospitals (18,828 beds, 5.4M BDOC)
- 132 nursing homes (33,408 ADC)
- 73 home care programs
- 43 domiciliary programs
- 206 veterans counseling centers
- 854 clinics (50 M outpatient visits)
- 186,600 employees (VHA)
- The largest integrated healthcare system in the US

## “With 1500 sites of care, VA
delivers health care in nearly every
community in the Nation. Thus, VA 
is a fine-meshed sieve for any
infectious disease of public health
significance. VA has to be
prepared for everything.”  

		J. Perlin, Under Secretary for Health
Forum on Microbial Threats - Board on Global Health
Institute of Medicine
Washington, DC – June 16, 2004

- delivers health care in nearly every
- community in the Nation. Thus, VA
- is a fine-meshed sieve for any
- infectious disease of public health
- significance. VA has to be
- prepared for everything.”
- 		**J. Perlin, Under Secretary for Health**
- Forum on Microbial Threats - Board on Global Health
- Institute of Medicine
- Washington, DC – June 16, 2004

## VHA StatisticsFiscal Year 2004

- 7.1 million total enrollees of 25 million US veterans
- 5.1 million patients treated
- $29 billion total budget
- 200 million 30-day equivalent Rxs dispensed
- 190 million lab tests performed

## Who Are VA Patients?

**Older** -  49% over age 65
**Sicker** - Compared to Age-Matched Americans
- 3 Additional Non-Mental Health Diagnoses
- 1 Additional Mental Health Diagnosis
**Poorer**
- 70% with annual incomes < $26,000
- 40% with annual incomes < $16,000
- 31% have no health insurance

## Education of Health Care Providers

- Affiliated with 107 of 125 U.S. Medical Schools and 1,200 education institutions
- 84,510 total trainees (AY 2001)
- VA has responsibility for the
- occupational health of trainees

## Research 

- FY04: $1.5 billion research budget
- Mission: improve veterans health care
- Medical Research
- Rehabilitation Research
- Cooperative Studies (large multi-center clinical trials)
- Health Services Research
- Accomplishments:
- Invention of cardiac pacemaker, CT technology
- First successful liver transplant, insulin pump
- Multi-center clinical trials; Tb, MI & CHF tx, HTN, DM
- 2 Nobel Prize winners, 6 Lasker Awards

## Emergency Preparedness

- VA/DoD Contingency (PL 97-174) – VA backs up DoD in event of war or national emergency involving armed conflict
- NDMS – VA, HHS, DoD, FEMA (DHS) – assists state/local govts with medical & PH  disasters and hospital capacity
- DEMPS – VA part of Federal Response Plan when Presidential Disaster Declaration in made
- Ad hoc – local responses to emergencies

**Notes:**
DEMPS = Disaster Emergency Medical Personnel System

## VA Pandemic Flu Preparedness 

- Annual Influenza Vaccination Program
- Under Secretary for Health’s Directive
- Resources to enhance vaccine uptake
- Performance measure
- Public Health Mission
- Oseltamivir stockpile
- Oseltamivir Concept of Operations Plan
- Respiratory Infectious Disease Emergency Plans and Operation Preparations (USH IL)

**Notes:**
The next few slides will review specific preparations VA is undertaking for pandemic flu.

## VA Annual Influenza Vaccination Program

- Under Secretary for Health Directive
- Communicates priorities, implementation issues, clinical issues
- Flu vaccine coordinator appointed at each facility
- Flu vaccine resource toolkit distributed throughout system
- Flu vaccine supplies purchased/distributed
- Flu vaccine Performance Measures established and monitored

**Notes:**
We will build any pandemic flu response (preps, education, vaccination – when available, oseltamivir use, etc) on established infrastructure of our flu vaccination program.

## VA Public Health Leadership

**Our Advisors—**
**VA Committee on Urgent Public Health Issues**
- Nat’l committee of VA ID, infection control, public health, unions, occupational health, management, human resources, communications, security
- Summer/Fall 2004 - agreed that pandemic flu was a significant risk to veterans and VA health care system
- Supported VA oseltamivir stockpile
- Regular advisors on operational/implementation issues

**Notes:**
We think about these issues with broad input from various voices.  

## Oseltamivir Stockpile

- Fall 2004 – VA purchased 5.75 million capsules
- Quantity based on supply needed for
- Treatment for 550 patients and staff
- Prophylaxis for 5000 patients and staff
- At 40 sites

## VA Oseltamivir StockpileConcept of Operations & Use Plan

**Stockpile divided in 7 geographically diverse locations**
**Physically at VA Community Mail-Out Pharmacy Centers (200m Rxs/year)**
**Plan to coordinate distribution with CDC/DoD**
- depending on epidemiology
- Geographic targeting for isolated or limited outbreak/control
- Widespread distribution for treatment and prophylaxis
**VA will act to protect veterans’ health when needed**
- prefers to work with CDC under the cooperative model of last year’s flu vaccine shortage

## Respiratory Infectious Disease Emergency Plans and Operational Preparations – USH Information Letter

**Instructions to VA facilities:**
**Preparations/planning needed**
**Pandemic responses**
**Follow-up actions post event**
**Areas of Preparations/Responses:**
- Communication
- Education
- Staffing and Human Resources
- Environmental, Facility, and Equipment
- Patient Care Management

## Slide 16