Broader Horizons for Immunization: Immunization and the Preparedness Mission Nicole Lurie, MD, MSPH Assistant Secretary for Preparedness and Response Rear Admiral, U.S. Public Health Service

H1N1 Accomplishments First anniversary of H1N1 discovery 11/19/2019 H1N1 Accomplishments First anniversary of H1N1 discovery Year marked by major accomplishments Worked with manufacturers to respond to H1N1 according to plan Successfully adapted existing immunization systems Vaccinated 72-81 million Americans with the H1N1 vaccine H1N1 tested our assumptions about a pandemic influenza vaccine campaign Now beginning to act on lessons learned H1N1 inspires a new way of thinking about immunization in this country Proud of government response to H1N1 pandemic The virus struck at a time when Americans seemed particularly skeptical about our government and large institutions. HHS faced an uphill battle to characterize the trajectory of the pandemic, to define its impact, to offer suggestions and to convince a wary public to get vaccinated. ASPR Role in H1N1, including BARDA and OPEO Response began with H5N1 – developing national pandemic plan Worked with manufacturers to respond to H1N1 according to plan Planning, practice, investment vaccine manufacturing capacity & development of new vaccine technology. 2009 H1N1 flu tested our previous assumptions about how a pandemic influenza vaccination program would roll out. We assumed the first vaccine to be used would be up to 20M doses of a pre-pandemic influenza vaccine stockpiled against the new circulating influenza virus; We assumed significant economic and social disruption requiring the use of the first limited initial doses to those essential to the pandemic response, those who maintain essential community services, and children; and We assumed a government-managed public sector vaccination campaign with limited ship-to sites. In the end the 2009 H1N1 influenza vaccination program looked much different then what was originally envisioned The program’s success was predicated on: A foundation of flexibility and accommodation of existing systems The hard working and dedicated people in this room. H1N1 also required that we do business differently and our new way of thinking can and should translate to day to day business.

Preparedness Concepts 11/19/2019 Preparedness Concepts Americans deserve a level of protection commensurate with the threats they face, regardless of where they live Variation in state vaccination rates suggests we can do better Preparedness depends on how well our systems work day to day In an emergency, everyone needs to know what to do, and to do their part Individuals, communities, businesses, schools, physicians… We must be prepared for all hazards, including those we cannot foresee, like newly emerging diseases Partnerships are essential preparedness isn’t something we do in our spare time, it is an every day effort – it needs to be integrated into everyday systems and work.

Some Ways Forward Reducing variations in health protection Learning what works and building on it Strengthen systems that need it Metrics Build and improve day-to-day systems Surveillance School based vaccination Systems for tracking vaccine (e.g. bar coding) Strengthening health homes and electronic health records Improving health care provider vaccination rates Routine vaccination rates, especially in minority populations Knowing what’s going on in closer to real time

More Ways Forward Everyone doing their part Prepare for all hazards Individuals/families Embracing prevention/health every day Following public health advice Schools and employers Stay home when sick Support/incentivize vaccination Health care providers and insurers Embrace public health roles and responsibilities Traditional and alternative vaccinators Vaccinate Educate Communicate Prepare for all hazards Medical countermeasure review and vaccine capabilities for the future

Even More Ways Forward Build community resilience 11/19/2019 Even More Ways Forward Build community resilience Everyone needs to have a plan, and reach out to those who are more vulnerable and need more help Partnerships are critical AT THE LOCAL LEVEL Build on those we have and those we have built Public and private sector Clinicians and communities New science Academia and industry-new vaccine technologies Operations research and supply chain science Communication/social science How can we harness new partnerships with the Education community and apply successes to future influenza seasons, other immunization campaigns and public health emergencies? Huge successes with this model in states across the country. Can we translate this model to how we think about use of childhood vaccines and future public health emergencies? How can we engage the healthcare sector differently – move beyond employer and big-box partnerships Connection between public health and medical communities needs to be strengthened - they are part of each other – they aren’t separate. Improve the number of private physicians both willing to recommend vaccination and then actually have the capacity to administer Improve vaccine use by OB/GYNs As broader and more integrated health care coalitions are fully developed with primary care, emergency care, and public health partners, these will serve as a strong foundation which will support scalable medical surge capabilities at the community, State, and regional levels.

Conclusions The National Health Security Strategy inextricably links our nation’s preparedness and immunization Requires capabilities beginning with surveillance, and ending with immunization Aligning immunization and preparedness missions makes good, day-to-day sense for both