1. Expanded Influenza Vaccination Recommendations: Developing an Implementation Strategy Litjen (L.J) Tan, MS, PhD American Medical Association Co-Chair, National Influenza Vaccine Summit

2. Disclaimer… The opinions expressed in this presentation are solely those of the presenter and do not necessarily represent the official position of the American Medical Association

3. The Current Influenza Vaccination Environment: An Ongoing Paradigm Shift  For providers and for the public  Crisis of shortage/delays to a crisis of surplus 27 million doses not distributed in 2007-08 season 27 million doses not distributed in 2007-08 season  To reduce mortality and morbidity, influenza immunization rates must increase by utilizing the entire season BUT it’s not about having more time to vaccinate the SAME people BUT it’s not about having more time to vaccinate the SAME people

4. The Changing Paradigm…   The traditional paradigm of influenza vaccination is no longer a valid model! Vaccine delivery complete by September/October Myth: Differences in delivery is reflection of distribution inequities Immunization should be complete by November And it’s not simply about telling providers to vaccinate throughout the season…

5. The Current Vaccine Supply and Distribution   Vaccine delivery complete by September/October As manufacturers make more influenza vaccine doses, vaccine will arrive over time through December and beyond, rather than in a short burst in October Nature of vaccine production and lot approval dictates that production lots of vaccine must be released over time Some years will be better/worse than others If we are vaccinating all recommended populations, we need to have vaccine still available in January!

6. The Current Vaccine Supply and Distribution   Improved vaccine distribution on ground by improved vaccine production More manufacturers More manufacturing capacity BUT Distribution differences will always exist Vaccine distribution important to all ‘Me first’ serves little purpose-there will always be some getting vaccine before others as long as all annual vaccine is not available well before the season   Increased vaccine production requires vaccine distribution to occur through entire influenza season

7. Full Season Immunization Is One Way To Improve Rates  Health care providers are hearing the expanded season message but are not equating it to immunizing MORE ACIP-recommended people.  Current influenza immunization rates are below HP 2010 goals -  Current influenza immunization rates are below HP 2010 goals - significant morbidity, mortality, and economic costs   Opportunities exist to immunize more patients   Vaccination is still effective well beyond December

8. The 18-years And Under Recommendation   Implementation will be challenging In 2008-09 the number of new vaccinees due to the 5-18 recommendation may be only about 8 million vaccinees 1   May place a burden on the traditional pediatric medical home   Innovative ways to reach these children must be considered 1 Complementary locations such as schools, with collaboration with the traditional pediatric provider Use epidemiologic and uptake data to target vaccination? What about the timing of influenza vaccination of school aged children (some or ‘all’)? Would it be realistic to split the children into an early season group and a later group? When which? Would second week in Sept. be too early to start the first group? What group? 1 Gary Euler, National Influenza Vaccine Summit, 2008

9. Expanded Recommendations May Provide More Opportunities For The Medical Home 1. Surveillance Data, Inc. (SDI), February 2008. Ad Hoc Report on Patients Aged 5 to 18 Years, January to December 2007. Based on nationally projected data from physician office electronic medical claims submitted on CMS-1500 forms for third-party reimbursement. 2. Claritas, Inc., a division of The Nielsen Company, 2007 U.S. Population Estimates by Age. Patient Visits 39 Million (69%) 5 through 18 year-olds had one or more visits to a primary care physician during the 2007 influenza season 1 (As of July 31, 2007 the US Census Population Estimate for the 5-18 year age group is 57,692,196) 2

10. Goals of Today’s Meeting  Bring together a broad range of stakeholders to identify coordinated next steps for implementing universal influenza vaccination recommendations So let us know who is missing from today’s meeting… So let us know who is missing from today’s meeting…

11. Objectives for Today’s Meeting  Develop a multi-sectoral public health national strategy to implement the expanded influenza vaccination recommendations  Identify creative and innovative implementation ideas  Identify the barriers to full and immediate implementation of expanded efforts on influenza vaccination and draft strategies to overcome these barriers

12. Operating Protocol…  Day One Large, then small group sessions to identify areas of agreement and disagreement, priority, and action. Large, then small group sessions to identify areas of agreement and disagreement, priority, and action.  Day Two Provide a forum for all participants to report back to the larger group on the first day’s small-group discussions/results Provide a forum for all participants to report back to the larger group on the first day’s small-group discussions/results Expand knowledge of the issues Expand knowledge of the issues  Identify specific commitments/actions that groups/individuals make to move forward implementation of the recommendation

13. Fair Game…  Financing, policy, and legislation  Public and provider education  Industry accountability and product control  Alternatives to the medical home – implications/challenges/opportunities  Strategic partnerships and building and supporting capacity for implementation

14. Anticipated Products…  Meeting proceedings to guide the development of a national strategy and to identify areas in which further discussion among partners is warranted The draft strategy will be shared with attendees for feedback and endorsement. (August 2008) The draft strategy will be shared with attendees for feedback and endorsement. (August 2008)  Publication of a special proceedings document that describes the meetings and the national strategy. (September/October 2008)

15. Small Group Breakouts  Workgroup One – School Settings Facilitator: Harry Hull, MD Facilitator: Harry Hull, MD Note-taker: Lilly Kan, MPH Note-taker: Lilly Kan, MPH  Workgroup Two – Healthcare and Other Settings Facilitator: Mitch Rothholz, RPh, MBA Facilitator: Mitch Rothholz, RPh, MBA Note-taker: Cindy Phillips, MSW, MPH; Samantha Austin Note-taker: Cindy Phillips, MSW, MPH; Samantha Austin  Workgroup Three – Supply, Distribution, and Financing Facilitator: Anna DeBlois Buchanan, MPH Facilitator: Anna DeBlois Buchanan, MPH Note-taker: James Ransom, MPH Note-taker: James Ransom, MPH