University of Michigan Health System Tracking and Evaluation of H1N1 Vaccine Implementation by Immunization Grantees Sarah Clark Child Health Evaluation and Research Unit (CHEAR) University of Michigan Association of Immunization Managers January 22, 2010

University of Michigan Health System Background H1N1 vaccine implementation was characterized by: –Federal guidance and structure –Substantial flexibility for implementation at the program level –Known unknowns and unknown unknowns

University of Michigan Health System Purpose To collect situational awareness data on H1N1 vaccine implementation –Collaborative approach –Useful in the short term To utilize situational awareness data in evaluating H1N1 vaccine implementation –Lessons learned based on experiences

University of Michigan Health System Methods – Phase 1 Build consensus with partners –AIM, ASTHO, CDC Determine data sharing mechanisms –High priority for program officials to receive data in a timely fashion –Concern about data becoming public Identify topics for data collection

University of Michigan Health System Data Collection – Phase 1 Data collection from immunization program managers, their designee, and/or H1N1 vaccine implementation lead 50 state and 4 metropolitan areas Mix of telephone and contacts: –Balancing concerns about time required for participation with complexity of questions and responses

University of Michigan Health System Data Collection – Phase 1 October 2, 2009 – ? –16 weeks (and counting) Fantastic participation by program officials The “UM All-Stars” –CO, CT, FL, KS, LA, NC, ND, OH, RI

University of Michigan Health System Data Dissemination to AIM membership via from AIM and members-only website to ASTHO membership via from ASTHO to CDC officials responsible for vaccine implementation*

University of Michigan Health System Impressions #1 There was substantial variation across programs from the outset. In other words, programs utilized the flexibility they were given.

University of Michigan Health System Results – Week of 10/2/09 Target populations for initial LAIV doses –healthcare workers (42) –Children months (32) –Children 5-9 years (26) –Children years (22) –Caregivers of young infants (4)

University of Michigan Health System Results – Week of 10/2/09 Target settings for initial LAIV doses –hospitals (29) –local public health (29) –private VFC providers (16) –private non-VFC (H1N1 only) providers (6) –community health centers (3) –Indian Health Service (3)

University of Michigan Health System Impressions #2 Program officials were asked to make complex decisions, often in a completely new context.

University of Michigan Health System Results – Week of 10/26/09 Allocation Strategies –Focus on large sites with priority populations (3) –Every provider gets something (7) –Percentage of total based on estimated priority patients (4) –Random selection of providers (1) –Match vaccine presentation with provider type (6) –Done by local public health partners (16)

University of Michigan Health System Impressions #3 The more things changed, the more things changed.

University of Michigan Health System ACIP Recommendation Initial target groups: Pregnant women Caregivers of infants <6 months Health care workers Children 6 months - 24 years Adults years with high-risk conditions

University of Michigan Health System ACIP Recommendation Subset of target groups (priority if vaccine supply is inadequate): Pregnant women Caregivers of infants <6 months Health care workers w/direct contact Children 6 months - 4 years Children 5-18 years with high-risk conditions

University of Michigan Health System Unexpected decreases in vaccine projections prompted programs to consider moving to priority groups. Data on H1N1 disease impact cross different risk groups was just beginning to emerge.

University of Michigan Health System Impressions #4 Program officials balanced competing demands from multiple levels.

University of Michigan Health System We hear you! “It would be nice if CDC would close down the rhetoric so we can get vaccine out and focus on what’s happening in our state. You can put that in BOLD print!”

University of Michigan Health System We hear you! “That’s a really good idea…But it doesn’t really matter what I think. Nobody listens to me anyway. Even if we make a decision, they’re just going to change it at the last minute anyway.”

University of Michigan Health System We hear you! “We’ve been doing this straightforwardly and transparently…The media have their own way of making it interesting.”

University of Michigan Health System We hear you! “We strive for generalized consensus with all the counties; we agree on something. And then the next day, they just all do whatever they want anyway. It’s insane.”

University of Michigan Health System We hear you! “65 and over is saying, Hey look at me! I have a condition!”

University of Michigan Health System We hear you! “I’m deluged with call from providers, and strange requests on top of that—like the guy who was about to get a hernia operation but needed the vaccine first.”

University of Michigan Health System Evaluation Goals of Phase 2: Document objectives, decisions, considerations, strategies across programs Incorporate what was known at the time Evaluate success in light of program-specific objectives and strategies Synthesize information to produce “lessons learned” that will inform the future

University of Michigan Health System Potential Evaluation Topics Decision-making Core principles and objectives Involvement of other agencies/entities Challenges of local control Information sources / adequacy If I had it to do over…

University of Michigan Health System Potential Evaluation Topics New relationships Challenges/successes with new provider groups School vaccination Opportunity for ongoing collaborations

University of Michigan Health System Potential Evaluation Topics Other areas Obtaining and using data Technical systems Strategies/programs to maintain for future (and how to fund them)

University of Michigan Health System Appreciation Anne Cowan, Brian Macilvain, Gary Freed Claire Hannan, Kaitlyn Wells Anna Buchanon, Kathy Talkington Pascale Wortley & team But most of all… AIM members

University of Michigan Health System