1. Jan Hicks-Thomson, MSW, MPA
Standing Up in a Crowd:
Implementing H1N1 Vaccine Response in Washington State
Jan Hicks-Thomson, MSW, MPA

2. SOME THOUGHT IT A PIG CONSPIRACY….

3. A Blended Family H1N1 PLANNING TEAM Vaccine Communication
Immunization Program
Emergency Preparedness
Communicable Disease Epi.
Board of Pharmacy
Pan Flu Coordinator
Communication
Emergency Preparedness
DOH Communication Office
Immunization Program
Community Mitigation
Immunization Program
Emergency Preparedness
C. D. Epidemiology.
Dept. of Education (OSPI)
Health Care
Immunization Program
Emergency Preparedness
Communicable Disease Epi.
Dept. of Education (OSPI)

4. Orienting Providers and Ourselves
Distribution
Allocations
Ordering
Inventory
Program Requirements
Storage and Handling
Vaccine Types
Ages
Presentation
Guidance
VAERS
Fraud / Abuse
Doses Administered
Accountability
Communication

5. Communication
We utilized our basic communication strategies – conducting conference calls, using extensive and web-posting to give information to local health departments and the provider community.

6. Just a Few
Conference Calls…

7. H1N1 Vaccine Ordering and Distribution Direct Distribution
H1N1 Providers
Local Health Jurisdiction (LHJ)
WA State Department of Health
CDC
Distributor
McKesson Specialty
CDC sends orders to Distributor
Distributor Fills Provider Order
Direct Ships to Provider
Provider Submits vaccine order or
Requests Allocation from LHJ
LHJ Approves Provider Orders and Submits to DOH
DOH Approves Processes All Orders
LHJ Clinic Inventory
Provider Clinic Inventory
1-2 day order submission timeline.
Electronic shipping file, with ground carrier tracking numbers sent to DOH when shipment leaves warehouse – typically 3 – 5 business days after receipt.
Existing providers – LHJ processes orders via VOMS
New providers – LHJ processes orders via paper form
Same day order processing.
Shipment data sent to LHJs at minimum 1x per week.
Information Exchange: Vaccine Product Flow: Vaccine Inventory:

8. H1N1 Vaccine Management Guidelines
These graphics depict the H1N1 Vaccine Management and Distribution Guidelines and the H1N1 Vaccine Ordering and Distribution Basics tools.
These guides will be shared on the Department of Health web-site.

9. Enrollment
Pre-registry included a check list to ensure providers understood what would be required of them if they participated in H1N1.
We conducted pre-registration through a web-based application.
Once pre-registered, we followed up with the Provider Agreement – at that time we designated providers as direct ship sites – those that could order the minimum 100 doses; and Administration Only those that could not. We also added a designation of Multi-site organization to designate providers with special circumstances due to their organizational structure.

10. Managing Multi-site Organizations
Direct ship
Central distribution w/redistribution
Cross county:
Special global PIN
9 Community Vaccinators:
37+ accounts
7 Pharmacies in CDC H1N1 Retail Pharmacy Program

11. H1N1 VACCINE DISTRIBUTION PLANNING?
!CAUTION!
Late Sept.
10/15/09
10/29/09
By End of Oct.
Prefilled Syringe
189,990
99,220
142,490
431,700
Multi-dose Vial
21,110
460,200
144,600
625,910
Nasal Spray
119,700
63,960
105,550
289,210
Total
330,800
623,380
392,640
1,346,819
H1N1 vaccine distribution may be managed by the LHJ in several ways:
They may choose to have vaccine direct shipped to providers.
They may choose to have vaccine shipped to the LHJ for use in PODs, or for redistribution to clinics within the jurisdiction that cannot use 100 doses of vaccine.
Information on the number of sites is evolving but we can safely say we expect it to be around 2100 total sites that vaccine can be shipped directly to from McKesson.
We will need to develop strategies that help us maximize vaccine access within the limits CDC sets. This may mean we want to work with larger provider organizations that can help by receiving vaccine at a central location, and redistributing it to their satellite clinics. A key to this is the ability of the organization to maintain the cold chain during transport and storage.
For Planning Only – Dates and Amounts Approximate; NOT yet Confirmed

12. H1N1 VACCINE DISTRIBUTION PLANNING
OB – Women’s Clinic
Specialty Provider
Ped. Practice
Family Practice
Comm. Vac.
Pharmacy
Pregnant Women X
Caregivers of Children <6 mos.
Health Care Workers
Person with Chronic Conditions
Young Children
Young Adults
Older Adults
The easiest organizations to work with will be those that operate within a single health jurisdiction, and maintain a central pharmacy with the capacity to manage redistribution.
LHJs will manage this within their jurisdictional allocation, and will make the decision about allowing the redistribution to take place.
If a large provider organization has satellite clinics in multiple jurisdictions, centralized ordering and receipt of vaccine must be coordinated across all affected LHJs. DOH will assist with this process as needed.
The involved LHJs will need to determine what portion of their H1N1 vaccine allocation they want to have sent to the central pharmacy of the organization. In the event an LHJ does not want to participate in this way with the parent organization, and chooses to work with the satellite clinic in their jurisdiction, they may do so. They will have to count the satellite clinics as separate sites for their jurisdiction for direct shipment.
DOH will work with LHJs and the organizations involved when the organization crosses multiple jurisdictions.

13. Population Based Allocation H1N1 Vaccine Order Tracking
Allocation and Distribution Strategies
Population Based Allocation
County
Shipment 1
Total
H1N1 Vaccine
Adams
120
Asotin
210
Benton - Franklin
920
Chelan - Douglas
380
Clallam
190
Clark
440
Benton-Franklin
H1N1 Vaccine Order Tracking
Shipment 1
H1N1 Vaccine
Total Shipment Allocation
920
Balance (MUST BE ≥ 0)
730
PIN
Provider Name
Approved
152002
Richland Family Medicine 50
152004
Chou, H.D. 40
H48001
Ham Pharmacy LLC
H52002
Wright OB/GYN Practice 20
Washingotn’s allocation strategy has two parts: One is a population based allocation – calculated for each geographic region
The second part is the allocation at the provider level – done at the time of ordering.
This second sheet is actually the order monitoring tool – it allows the allocation at the geographic level to be monitored as each order is requested; this tool helped us stay within our allocation through the duration of the shortage.
It also allowed us to know where vaccine might be available, and where it was short so we could facilitate virtual and real transfers and move the vaccine around as needed.
Three types of provider identification numbers were used – regular childhood providers used their current PIN; H1N1 providers used an H PIN, followed by the code designating the local health jurisdiction they resided in; and finally, the multi-site organization or centralized distribution sites we designated with an H48 PIN.

14. Allocation Strategy Re-defined…
* In mid October through November, DOH transferred 10 to 30 H1N1 doses
* The donor and the recipient were identified by LHJ
* The transfer process helped LHJ to order in the 100 dose increments
* In mid December, LHJ was ready to donate the vaccines, but had no recipients
* DOH had to identify the recipients
* Seattle – King
Tacoma – Pierce
Thurston
* In mid December, DOH started their own stock pile
* Special tracking tool and ordering directions

15. Vaccine Ordering and Monitoring

16. Doses Administered / Accountability
Inventory Management for H1N1 Vaccine
Allowed three methods – fax, registry and on-line portal
Department of Health On-line reporting:
Requires provider to have web access
Will be similar to the on-line pre-registration process
No patient specific data available
Aggregate doses administered
By age
Electronically captured by DOH staff
LHJ level data reports made available
By age, priority group
For the jurisdiction

17. CHALLENGES Disposal Management Supply Kits Adjuvant Needles
Sharps Containers
Not Enough
Too Much
Recalls
Short Dating

18. Doses Administered Reporting Clinical Forecasting - Management
Registry Use
Doses Administered Reporting
Clinical Forecasting - Management
Mass Immunizations
Rates and Recall

19. H1N1 Provider Enrollment
Whatcom 76
N.E. Tri 26
San Juan 10
Island 24
Okanogan 18
Ferry
Skagit 49
Stevens
Pend Oreille
Snohomish
184
Clallam 44
Jefferson 13
Chelan / Douglas 30
Kitsap 130
Spokane 216
King 767
Lincoln 3
Mason 27
Grays
Harbor 34
Grant 24
Kittitas 16
Pierce 303
Adams 4
Whitman 16
Lewis 38
Yakima 95
Benton / Franklin 106
Thurston 106
Cowlitz 29
Pacific 15
Klickitat 4
Wahkiakum 2
Walla Walla 18
Columbia 2
Asotin 13
Clark 134
Garfield 2
Skamania 2
35 Local Health Jurisdictions Provider Sites

20. Allocations and Ordering
9/30
71,200
10/15
261,200
1/29
3,092,400
11/15
952,200
Allocated Approved Available
2,820,600 2,307, ,900

22. The Childhood Vaccine Program
UP Transition
Seasonal Influenza
Hib Allocations
E.O.Q.
ARRA
Legislative Session

23. IT WAS OUR CALL TO ACTION…
WE KEPT OUR ACT TOGETHER…
Thanks to the WA Vaccine Mgt. Team!

24. AND GOT THE JOB DONE… =
ALONG WITH OUR PUBLIC HEALTH COLLEAGUES ACROSS THE NATION

25. Contact: Jan Hicks-Thomson, MSW, MPA