Preparing for A Severe Influenza Pandemic: Expanding the Approach to Vaccine Response
Samuel B. Graitcer, M.D. CDC Pandemic Influenza Vaccine Task Force
Immunization Services Division National Center for Immunizations and Respiratory Diseases
Historical Approaches to Pandemics
Prior to 2009, pandemic planning assumed most vaccination would occur in mass vaccination clinics 1976, 45 million persons vaccinated over 2.5 month period, public health lead effort
During 2009 H1N1, Vaccines for Children (VFC) program infrastructure was also utilized Epidemiology suggested increased susceptibility to 2009 H1N1 infection in younger age groups VFC is entitlement program which provides vaccines to under/uninsured children and includes many pediatric providers VFC has robust vaccine distribution system in place >120 million doses distributed over 5 months ~5 million vaccine doses administered during peak vaccination week of 2009 H1N1, after ~4 months of planning
Epidemiology of Next Pandemic Likely Different Than 2009 H1N1 2009 H1N1 Characteristics
Potential Future Pandemic Characteristics
Higher in younger groups
All ages
Mild-moderate
High in all ages
No. of vaccine doses required
One dose; except for <9 years
2 doses for all ages
Use of adjuvant
Not used
Probable
Mild-moderate
Likely high if severe disease and vaccine available before peak illness
Susceptibility Severity
Demand for vaccination
Preparedness Goals: Severe Influenza Pandemic
Ensure systems in place to vaccinate 80% of population 2 vaccine doses with adjuvant separated by 21 days for all ages
Be ready to vaccinate at maximum capacity (≥30 million doses per week) as soon as possible Potential timing of vaccine availability is 60 days after decision to produce and distribute vaccine
Reaching these goals will require major efforts: Enroll new providers, outside of VFC, to reach much larger group of population, especially adults Leverage additional partners and systems
Leveraging the Strengths of Public Health and Private Sector Within Existing Scope of Public Health Programs
Mass Vaccination/ PH clinics
VFC Providers
Adult Providers/ Independent Pharms.
Retail Chain Pharmacies
Pharmacists as Vaccinators
Since 2009, more seasonal influenza vaccination is done in retail settings, pharmacies ~20% all adult influenza doses administered in retail settings
Significant capacity for vaccination by pharmacists >230,000 immunizing pharmacists ~61,000 pharmacies in US (NACDS, 2011) 93% of Americans currently live within 5 miles of a retail pharmacy (NACDS, 2011)
Public health infrastructure reduced since 2008: ~45K less public health workers (Trust for America’s Health, 2013; http://healthyamericans.org/report/105/)
Preliminary (unpublished) models from CDC with state input suggest the addition of pharmacies may: Significantly improves weekly vaccine administration capacity Cuts time to 80% vaccination coverage for adults in about half
Public Health and Pharmacies: Next Steps for Pandemic Partnerships
Formally integrate pharmacists into pandemic planning and routine immunization landscape Clarify roles and processes for distribution, ordering, information sharing, and use of immunization registries Begin integration into pandemic preparedness now, before the next pandemic, for full potential Every state/ county may approach partnership differently, shared key principles will improve national program Examples of next major step: Implementation of Memorandums of Understanding with shared principles in states
For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail:
[email protected] Web: www.cdc.gov
EXTRA SLIDES
