1. State Experiences during Different Stages of the H1N1 Pandemic
Quite a Journey!
State Experiences during Different Stages of the H1N1 Pandemic
Sarah Clark
Child Health Evaluation and Research (CHEAR) Unit University of Michigan
April 20, 2010

2. Background H1N1 vaccine implementation was characterized by:
Federal guidance and structure
Substantial flexibility for implementation at the program level
Tight timeframe for planning
Overwhelming amount of information

3. Purpose
To collect situational awareness data on H1N1 vaccine implementation
Collaborative approach
Real-time feedback
To utilize situational awareness data in evaluating H1N1 vaccine implementation
Lessons learned based on experiences

4. Data Collection
Immunization program managers & staff and/or H1N1 vaccine implementation lead
50 state and 4 metropolitan areas
Telephone and contacts

5. Destination Unknown

6. Destination Unknown H1N1 was…
different from pandemic planning scenarios
but different from childhood vaccination
Most programs [eventually] struck a balance between the two.

7. What time do we leave? Waiting for information
Vaccine distribution system
Provider agreement
Billing guidance
Information drives decision-making, facilitates implementation

9. 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

10. ACIP Recommendation If vaccine supply is inadequate: Pregnant women
Caregivers of infants <6 months
Health care workers with direct patient contact
Children 6 months - 4 years
Children 5-18 years with high-risk conditions
But even with these smaller “subpriority groups” there was not enough vaccine initially for the total population. What to do?

11. State Decisions 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)

12. Other key considerations
Working with new providers
registration, communication, assistance
Allocation of vaccine to each site
estimated need, formulations
Reporting and accountability mechanisms
tension between ease of use and need for accurate data
Even with guidance, there were simply some decisions that had to be made with little data.

13. Are we there yet?

14. Are we there yet? New destinations built on H1N1 success:
Relationships with new providers
Expanded use of immunization registries
New communication tools
Expanded school-based vaccination

15. At all levels---federal, state and local---the H1N1 vaccine implementation was characterized by:

16. Overall impressions H1N1 vaccine implementation was characterized by:
Thoughtful decision-making
Innovation and flexibility
Dedication
At all levels---federal, state and local---the H1N1 vaccine implementation was characterized by:

17. Acknowledgments University of Michigan team: AIM
Anne Cowan, Brian Macilvain, Gary Freed
AIM
Claire Hannan, Katelyn Wells
State immunization officials!