Mass Vaccination for the 2009 H1N1 Pandemic: Approaches, Challenges, and Recommendations

Abstract

The 2009 H1N1 pandemic stimulated a nationwide response that included a mass vaccination effort coordinated at the federal, state, and local levels. This article examines a sampling of state and local efforts during the pandemic in order to better prepare for future public health emergencies involving mass distribution, dispensing, and administration of medical countermeasures. In this analysis, the authors interviewed national, state, and local leaders to gain a better understanding of the accomplishments and challenges of H1N1 vaccination programs during the 2009-10 influenza season. State and local health departments distributed and administered H1N1 vaccine using a combination of public and private efforts. Challenges encountered during the vaccination campaign included the supply of and demand for vaccine, prioritization strategies, and local logistics. To improve the response capabilities to deal with infectious disease emergencies, the authors recommend investing in technologies that will assure a more timely availability of the needed quantities of vaccine, developing local public health capacity and relationships with healthcare providers, and enhancing federal support of state and local activities. The authors support in principle the CDC recommendation to vaccinate annually all Americans over 6 months of age against seasonal influenza to establish a standard of practice on which to expand the ability to vaccinate during a pandemic. However, expanding seasonal influenza vaccination efforts will be an expensive and long-term investment that will need to be weighed against anticipated benefits and other public health needs. Such investments in public health infrastructure could be important for building capacity and practice for distributing, dispensing, and administering countermeasures in response to a future pandemic or biological weapons attack.

Implementation of a Pharmacy-Based Adult Vaccine Benefit: Recommendations for a Commercial Health Plan Benefit

“…This public health crisis highlighted the role that pharmacists can play and positioned the profession to continue advancing immunization opportunities that improve public health by reaching patient populations in need or at risk. 15,16 There was consensus that adult vaccination rates would also improve if patients had a pharmacy-based immunization benefit. Furthermore, health plan panelists indicated that physicians often carry a limited number of vaccines and that the provision of vaccinations may be a poor utilization of physician time.…”

Changes in Immunization Program Managers' Perceptions of Programs' Functional Capabilities during and after Vaccine Shortages and pH1N1

“…24,25 Working with providers to distribute vaccine required effective communication with providers. 9,10,13,18 This enhanced communication with providers, especially those who cared for high-risk patients, might have also increased the ability to push out vaccine-related communication to providers. 2 The tracking of adverse events associated with this new vaccine was a priority for the federal government and impacted states and providers through enhanced tracking of adverse events associated with the vaccine.…”

“…10 While health departments attempted to prioritize high-risk groups, reallocation of the vaccine was likely necessary because of (1) the way the vaccine was packaged for delivery (i.e., shipment sizes too large for a given practice's needs), (2) the vaccine formulation recommended or contraindicated for certain groups, and (3) the elevated need in some places but not others. 18 This shortage called for the ability of jurisdictions to move vaccines between provider sites. 28 This policy change was necessary in the context of an emergency.…”

A literature review to identify factors that determine policies for influenza vaccination

“…This information was generally provided by surveillance networks, virology laboratories, and national health institutes. By contrast, for pandemics, modelling had a greater impact [73][74][75]. Furthermore, new factors influenced the decision because of the limited data regarding the clinical and epidemiological aspects of pandemics and the ethical and logistical challenges, including public acceptability [33].…”