1. Public Health Service Response to Influenza Vaccine Supply Problems Lance E. Rodewald, MD Immunization Services Division National Immunization Program CDC

2. Scope of CDC Talk What we were worried about What was done What happened so far Programmatic lessons learned so far

3. Basic Chronology Notification of CDC of possible enforcement actions MMWR announcing delay, possible shortage ACIP recommendations for delay scenario published Jan 1Dec 31

4. What We Were Worried About Vaccine shortage –Each 1M doses to elderly translates to 900 deaths 1,300 hospitalizations –Estimates of supply not reassuring –Vaccine supply dependant on manufacturer –Primarily private sector distribution Targeting vaccine during shortage

5. What Was Done Communicate with partners –Federal agencies –Public health and private providers Guarantee production of more vaccine Develop web site Generate new knowledge Create good practices material Conduct media campaigns

6. Federal Contract for Influenza Vaccine Production 9 million doses of influenza vaccine –Doses would not have been made without contract –Availability: mid-December, 2000 –Approximate prices $3 - public sector $5 - private Public health priority on purchase –Purpose: implement ACIP targeting policy –Purchase by application only Reviewed, ranked, prioritized by algorithm Application to Aventis

7. Vaccine Production Purchase Chronology Notification of CDC of possible enforcement actions MMWR announcing delay, possible shortage ACIP recommendations for delay scenario published Funds certified for 9M doses MMWR: web site taking orders Vaccine ships

8. CDC Web Site www.cdc.gov/nip www.cdc.gov/nip Vaccine availability –Links providers with vaccine to those without –Information only – not a vending site Vaccine available from manufacturer or wholesaler Links to states willing to redistribute –Initially, no vaccine on the web site –More valuable as season progresses Information –ACIP / MMWR statements –Links to news, surveillance, etc. Helpful material for providers

9. New Knowledge Provider-based studies (U. Michigan) –Focus groups –Quantitative survey Public-targeted studies –Focus groups in urban areas

10. One-Page Brochures for Providers’ Use Flyers desirable, according to physicians Messages developed through focus groups –Barriers to vaccination –Motivators to get vaccinated Three brochures are being finalized –Who is at high risk? –Don’t delay getting vaccinated –Your vaccination also protects others Wide availability of brochures

11. Media Campaign Harrison Maldanado and Associates (HMA) Target audience –African-Americans –Hispanic Americans –General population Media: TV, radio, outdoor/transit ads Material made available to all partners Two-phase campaign –Mid-November: high risk vaccination –Dec. – Jan.: It is not too late to get vaccinated

12. What Happened So Far Delay was as predicted by FDA Media campaigns conducted on time Total supply similar to last year –Time-related vaccine shortage occurred Variation in timing of order fulfillment Many upset providers –Vaccination campaigns delayed / cancelled –Spot vaccine price rose and fell CDC-procured 9M doses of vaccine –Available as scheduled –Did not sell well

13. Vaccine Production Purchase Chronology Notification of CDC of possible enforcement actions MMWR announcing delay, possible shortage ACIP recommendations for delay scenario published Funds certified for 9M doses MMWR: web site taking orders Vaccine ships

14. CDC-Procured Vaccine Safety-net vaccine Orders of intent to purchase –Would be prioritized by algorithm –Peak 4.5M doses Actual orders made –Purchaser could withdraw intent –Total so far: 1.5M doses –16% of the 9M doses

15. Programmatic Lessons Learned So Far Vaccine supply is fragile Vaccine must be available on time Distribution is private –Third-party distributors prominent –Early contracts with penalty clauses –Physician ordering behavior difficult to change –Limited ability to influence private market –Must engage private sector early Vaccine demand is time sensitive –Matching supply and demand challenging –Currently there is a vaccine surplus

16. Lessons Learned (2) Targeting vaccination requires –Change in behavior –State and local public health infrastructure to target vaccination efforts –Private sector capabilities currently unavailable Effective communications

17. We Were Fortunate Because Not an early influenza season –4 of last 18 seasons (22%) peaked in Dec. –Time-sensitive shortage  more impact Total supply available this year was similar to last year –Able to reassure that vaccine will arrive Not a pandemic year