The Ontario Experience National Immunization Conference FLU SHOTS FOR ALL The Ontario Experience Dr. Susan Tamblyn Medical Officer of Health Perth District Health Unit Stratford, Canada National Immunization Conference May 11, 2004

Ontario (pop 12 m)

Background of the Ontario Universal Influenza Program publicly funded program since 1989 for seniors and persons at high risk expanded in 1999 to health care workers and essential service workers (police, fire, ambulance) July 25, 2000 - universal program announced - free vaccine for everyone from six months of age

Program Goals reduce seasonal impact of influenza on the health care system, especially emergency departments decrease number and severity of influenza cases reduce economic impact of influenza cases

Program Evaluation Who gets vaccinated? How is it accomplished? - population-based coverage surveys (2000/01 and 2002/03) How is it accomplished? - Health Unit surveys in 2000 and 2001 - ongoing market research Is the program achieving its expected outcomes? - multi-year studies to look at impact on health care utilization, outcomes and economic parameters

Provincial Role in the Universal Influenza Program vaccine purchase and distribution to local health departments funding for vaccine administration workplace campaign province-wide communications campaign

Local Public Health Department Role distribution of vaccine to family doctors, hospitals, long term care facilities, workplaces public and professional education provision of public clinics with community partners

Community Clinics clinic sponsors included health units, workplaces, hospitals, community health centres, long- term care facilities and pharmacies new partnerships provided resources, access to target groups and increased reach most health departments added contract staff and volunteers

Community Clinics cont’d popular clinic sites included schools, malls and community halls (familiar and accessible sites) most popular hours were early afternoon to evening some health units held clinics at each school using written parental consent novel experiments eg drive-in clinics for disabled persons

Influenza Vaccine & Children 2000/01 Ontario coverage was 20% for age 0-4 and 30% for age 5-18 years higher rates in health units with school-based clinics eg. Perth 30% (<4) and 46% (5-18) as gatekeepers, physicians and nurses need more information on burden of disease and benefits of vaccine

Pandemic Preparedness in first year health units had only eight weeks to design and deliver a universal program “short supply” scenario tested because of vaccine delays in first two years local experience in mass clinics (best sites, times, use of volunteers) public and professional familiarity with flu shots enhanced manufacturing capacity

Conclusions An annual influenza vaccination program for the entire population: is feasible is sustainable encourages vaccination in targeted and high risk groups improves pandemic preparedness

Acknowledgments Dr. Karim Kurji and Dr. Paul Masaba, Ontario Ministry of Health and Long-Term Care Helen Johansen, Statistics Canada Dr. Valerie Mann & PHRED Evaluation Team Contact: tamblyn@pdhu.on.ca