1. 1 Flu Vaccine Shortage – 2004-2005 Department of Veterans Affairs Experience Lawrence R. Deyton, MSPH, MD Chief, Public Health Department of Veterans Affairs National Vaccine Advisory Committee February 8, 2005

2. 2 Outline  Who is VA?  Usual Flu Vaccine Program  Response to the Shortage  Lessons Learned

3. 3 Who is “VA” ? Veterans Health Administration  5.1 million patients, ~ 7.5 million enrollees  ~ 1,300 Sites-of-Care  158 medical centers or hospitals,  ~ 850 clinics, long-term care, domiciliaries, home-care programs  ~ $27.4 Billion budget  ~193,000 Employees (~15,000 MD, 56,000 Nurses, 33,000 AHP)

4. 4 Who is “VA” ? Veterans Health Administration  Affiliations with 107 Academic Health Systems  Additional 25,000 affiliated MD’s  Largest provider of health professional education  Most US health professionals (70% MD’s) have some training in VA (80,000+ trainees in 2004)  ~ $1.7 Billion Research Program  Basic, Clinical (Cooperative Studies), Rehabilitation, Health Services

5. 5 Fully Deployed Electronic Health Record

6. 6 Clinical Reminder System Contemporary Expression of Practice Guidelines Drives Performance Time & Context Sensitive Reduce Negative Variation Create Standard Data set

7. 7 Typical Flu Program Cycle  January—contract written for next year’s purchases  Summer—Influenza Program Directive drafted— priorities, clinical information  Summer—Influenza Tool Kits prepared  Early Fall—Influenza Program Directive released; Tool Kits distributed; vaccine shipments begin to arrive  Throughout year—ID, Public Health, Pharmacy, Prevention meet regularly to plan, trouble-shoot

8. 8 VA’s Flu Vaccine Purchases YearDoses Purchased 1998986,530 19991,163,250 20001,461,280 20011,841,760 20021,587,250 20032,049,750 20042,190,230 2005 estimate2,486,000

9. 9 VA Flu Immunization Performance Measure Rates—Chart Review FY 03 FY 04 VA Goal 03-04 HP 2010 Goal All Veterans (> 49 yo, or w/ chronic illness ) 70%75%79-82%90% Source: External Peer Review Program (EPRP) Surveys, 2003 and 2004, 11 clinics + SCI & D

10. 10 Veterans’ Self-Reported Vaccination Rates  FY 03 All (> 49 yo) 75% >64 yo 84% NH Whites 74% NH Blacks 60% Non-VA vaccine 45% n=102,347  FY 04 All (> 49 yo) 82% >64 yo 88% NH Whites 83% NH Blacks 72% Non-VA vaccine 38% n=159,142 Source: Survey of Healthcare Experiences of Veterans (SHEP)

11. 11 October 5, 2004—Potential Eligibles within VA System VA Worst-Case Scenario  Estimated 80% of 7.5 million enrollees  over 65  or with qualifying chronic illness  Estimated 60% of VHA employees  + trainees + volunteers  Total vaccine potential need 6 M doses following revised CDC criteria  VA expected < 2.2 mil doses

12. 12 VA—Response to Shortage  Assessed VA purchase: 100% purchased from Aventis Pasteur  Expected shortage: in 2003-4 season, of those who got vaccinated, 38% got it from non-VA source  Most of these expected to come to VA for vaccination  Entered discussions with CDC and AP to assure VA vaccine supply

13. 13 VA—Response to Shortage Six VA Under Secretary for Health “Flu Vaccine Advisories” October - January  Established priority groups to receive vaccine  Defined “hands-on” health care providers  Provided contacts for questions  Provided status updates of vaccine supplies  Clarified VA relationship to state/local health departments  Recommended appropriate use of antivirals  Redefined priority groups

14. 14 VA—Response to Shortage  Distributed Advisories broadly via email and other channels  Arranged purchase of LAIV  Re-assessed regional supplies of vaccine in mid-December  Re-distributed vaccine within VA regions in December and January  Removed restrictions January 21, 2005

15. 15 Estimated Usage 2005  21 VHA regions surveyed mid-December, 2004  73% of vaccine used (range 58% to 91%)  Within-region re-distribution occurred  No region needed more

16. 16 Ongoing Activities  Non-vaccine preventive measures encouraged in a national campaign: Infection: Don’t Pass It On http://www.publichealth.va.gov/infectiondontpassiton

17. 17 Lessons Learned  Multiple Sources for VA Vaccine Needed  Clear, timely communication is vital  Within VA  With CDC, state/local health departments & other agencies  With pharma  Needed:  understanding of patient decision-making surrounding immunization  data on vaccine uptake, outcomes within VA  ongoing education of patients and staff about importance of flu vaccine, differences in formulations, non-vaccine preventive measures

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