1. Sean O’Leary, MD Fellow, Pediatric Infectious Diseases
Willingness to Administer Influenza A (H1N1) 2009 Monovalent Vaccine: A National Physician Survey
Sean O’Leary, MD
Fellow, Pediatric Infectious Diseases

2. Background
The appearance of a novel strain of influenza in 2009 led to a global pandemic, the ramifications of which continue to unfold
There was a rapid international response, including the expedited production of a vaccine
Before the vaccine became available, it was unknown how willing primary care physicians would be to administer it

3. Objectives
To determine among U.S. pediatricians (Peds), family medicine physicians (FM), and general internists (GIM):
1) Willingness to administer 2009 H1N1 vaccine with limited information regarding safety and efficacy
2) Barriers to administering the vaccine
3) Preferences about receipt of public health-related information about H1N1 disease and vaccine

4. Context of Survey 2009 H1N1 virus identified in April 2009
Development of survey started in early June
Survey administered July through October with content based on early information about anticipated vaccine
Vaccine administration started in October for most of country

5. Methods: Survey Population
Survey conducted in 3 existing sentinel physician networks
Physicians practicing >50% primary care were recruited from random samples of AAP, AAFP and ACP
Quota sampling done to ensure networks similar to overall AAP, AAFP and ACP memberships
Previous study* comparing sentinel network methodology to most commonly used method of randomly sampling from AMA masterfile found comparable results with respect to:
Physician and practice characteristics
Responses on surveys regarding vaccine-related issues
*Crane LA, Eval & Health Prof, 2008 5

6. Methods: Survey Design
Survey developed jointly with CDC with input from national vaccine experts
Pre-tested in advisory committees of Peds, FM, and GIM physicians from across country and piloted among 196 primary care physicians
Brief internet and mail methods

7. Survey Administration
Survey Period: July - October 2009
Administered by Internet or mail depending on preference of physician
1/3 by mail
2/3 by Internet 7

8. Survey Content
Respondents provided with specific information regarding what was known about H1N1 vaccine at the time
In the context of this information, they were asked about:
Willingness to administer vaccine
Potential barriers to administering

9. Information Provided
“The FDA has not yet made the decision about whether the new H1N1 vaccine will be a licensed product or a product used under an Emergency Use Authorization (EUA).”
“If the vaccine is used under EUA it will require that providers give fact sheets to patients and track patient information for the FDA but physicians will not have to obtain informed consent.”
“The seasonal and H1N1 vaccines will not be combined into one shot but it is likely that seasonal influenza and H1N1 vaccine doses can be given at the same time.”

10. Information Provided
“It is anticipated that anyone <50 years will need to receive two doses of the new H1N1 vaccine.”
“Children <9 years who have not received 2 influenza doses in previous seasons will require 2 doses of seasonal and 2 doses of H1N1 vaccine.”
“It is not known when H1N1 vaccine will be available but supplies may be extensive.”
“Side effects of the H1N1 vaccine are expected to be similar to seasonal influenza vaccine.”

11. Results: Survey Response
76% response rate overall
FM: 70% (298/424)
Peds: 79% (330/416)
GIM: 78% (337/432)
Among the specialties, respondents not significantly different from non-respondents with respect to gender, birth year, practice location, region, and practice type
Need to update the RR?

12. Physician Willingness to Administer the H1N1 Vaccine During the 2009-2010 Season
Level of Willingness

13. Physician Willingness to Administer H1N1 Vaccine to Uninsured Patients Unable to Pay an Administration Fee
Level of Willingness

14. Top 3 Anticipated Barriers to Administering the New H1N1 Vaccine (Peds, FM, and GIM combined)
68%
60%
Get rid of bottom two; put “top 3 barriers” at top
43%
*Peds and FM ONLY

15. Anticipated Barriers to Administering Both New H1N1 and Seasonal Influenza Vaccines
(FM, GIM, and Peds combined)
75%
68%
55%
23%
*FM and Peds ONLY
**FM and GIM ONLY

16. Preference for Receiving Public Health-Related Information about Seasonal or H1N1 Influenza Vaccines from a Reliable Source (CDC/ACIP)
Highest in top, get rid of lowest, change colors
*Initiated by the CDC (Twitter, Facebook, blogs, RSS feeds, Widgets, e-health briefs, etc)

17. Limitations Respondents may have differed from non-respondents
Sentinel physicians may differ from physicians overall (prior work suggests not)
Survey results represent reported practice; actual practice not observed
The survey took place during a rapidly changing landscape with respect to disease and vaccine

18. Summary of Results
The majority of physicians surveyed were very or somewhat willing to provide 2009 H1N1 vaccine
The greatest perceived barriers among physicians were patient and parent safety concerns and the need for 3 or more separate administrations
, mail, and updates via the CDC website were the preferred methods of communication

19. Conclusions
Although potential barriers were noted, our data suggest that private providers would be willing partners in the delivery of a new vaccine in the face of a pandemic, such as the 2009 H1N1 vaccine
Such information will be useful in the future in the event of another pandemic or other emerging infectious disease

20. Vaccine Policy Collaborative Initiative
University of Colorado Denver
Principal Investigator - Allison Kempe, MD, MPH
Sean O’Leary, MD
Matt Daley, MD
Lori A. Crane, PhD, MPH
Laura Hurley, MD, MPH
Fran Dong, MS
Christine Babbel, MSPH
L Miriam Dickinson, PhD
Christina Suh, MD
Laura Seewald, BA
Claire Gahm, BA
CDC Collaborators
Shannon Stokley, MPH
Pascale Wortley, MD, MPH
Funding
CDC, through American Academy of Medical Colleges (AAMC)

21. Additional Information

22. Pediatricians’ Influenza Vaccination Practices During the 2008-2009 Influenza Season
*CMC= Chronic Medical Condition

23. Family Medicine Physicians’ Influenza Vaccination Practices During the 2008-2009 Influenza Season
*CMC= Chronic Medical Condition

24. Barriers to Administering Both the New H1N1 and the Seasonal Influenza Vaccines
Peds FM
GIM
Barrier
Significant %
Moderate %
Moderate %
If 3 or more visits are required to administer all doses of both vaccines 38 36 32 29
Parent unwillingness to allow their child to receive up to 4 different injections 34 43 30 42 --
Patient or parental concerns about the safety of the new H1N1 vaccine 35 24 20 40
Lack of data about the efficacy of the new H1N1 vaccine 25 44 19 22 37

25. Barriers to Administering Both the New H1N1 and the Seasonal Influenza Vaccines
Peds FM
GIM
Barrier
Significant %
Moderate %
Moderate %
Physician concern about the safety of the new H1N1 vaccine 15 35 14 26 25
If the vaccine had to be given under an Emergency Use Agreement requiring physicians to give patients a fact sheet and report basic information to the FDA 23 8 27 10 28
Inadequate storage space for both vaccines 19 6 16 5
Physician perception that the new H1N1 vaccine is a necessary vaccine 2
Unwillingness of adult patients to receive two different influenza vaccines -- 39 18 38

26. Preference for Receiving Public Health-Related Information about Seasonal or H1N1 Influenza Vaccines from a Reliable Source (CDC/ACIP)
*Initiated by the CDC (Twitter, Facebook, blogs, RSS feeds, Widgets, e-health briefs, etc)