1. Broader Horizons for Immunization:
Immunization and the Preparedness Mission
Nicole Lurie, MD, MSPH
Assistant Secretary for Preparedness and Response
Rear Admiral, U.S. Public Health Service

2. H1N1 Accomplishments First anniversary of H1N1 discovery
11/19/2019
H1N1 Accomplishments
First anniversary of H1N1 discovery
Year marked by major accomplishments
Worked with manufacturers to respond to H1N1 according to plan
Successfully adapted existing immunization systems
Vaccinated million Americans with the H1N1 vaccine
H1N1 tested our assumptions about a pandemic influenza vaccine campaign
Now beginning to act on lessons learned
H1N1 inspires a new way of thinking about immunization in this country
Proud of government response to H1N1 pandemic
The virus struck at a time when Americans seemed particularly skeptical about our government and large institutions. HHS faced an uphill battle to characterize the trajectory of the pandemic, to define its impact, to offer suggestions and to convince a wary public to get vaccinated.
ASPR Role in H1N1, including BARDA and OPEO
Response began with H5N1 – developing national pandemic plan
Worked with manufacturers to respond to H1N1 according to plan
Planning, practice, investment vaccine manufacturing capacity & development of new vaccine technology.
2009 H1N1 flu tested our previous assumptions about how a pandemic influenza vaccination program would roll out.
We assumed the first vaccine to be used would be up to 20M doses of a pre-pandemic influenza vaccine stockpiled against the new circulating influenza virus;
We assumed significant economic and social disruption requiring the use of the first limited initial doses to those essential to the pandemic response, those who maintain essential community services, and children; and
We assumed a government-managed public sector vaccination campaign with limited ship-to sites.
In the end the 2009 H1N1 influenza vaccination program looked much different then what was originally envisioned
The program’s success was predicated on:
A foundation of flexibility and accommodation of existing systems
The hard working and dedicated people in this room.
H1N1 also required that we do business differently and our new way of thinking can and should translate to day to day business.

3. Preparedness Concepts
11/19/2019
Preparedness Concepts
Americans deserve a level of protection commensurate with the threats they face, regardless of where they live
Variation in state vaccination rates suggests we can do better
Preparedness depends on how well our systems work day to day
In an emergency, everyone needs to know what to do, and to do their part
Individuals, communities, businesses, schools, physicians…
We must be prepared for all hazards, including those we cannot foresee, like newly emerging diseases
Partnerships are essential
preparedness isn’t something we do in our spare time, it is an every day effort – it needs to be integrated into everyday systems and work.

4. Some Ways Forward Reducing variations in health protection
Learning what works and building on it
Strengthen systems that need it
Metrics
Build and improve day-to-day systems
Surveillance
School based vaccination
Systems for tracking vaccine (e.g. bar coding)
Strengthening health homes and electronic health records
Improving health care provider vaccination rates
Routine vaccination rates, especially in minority populations
Knowing what’s going on in closer to real time

5. More Ways Forward Everyone doing their part Prepare for all hazards
Individuals/families
Embracing prevention/health every day
Following public health advice
Schools and employers
Stay home when sick
Support/incentivize vaccination
Health care providers and insurers
Embrace public health roles and responsibilities
Traditional and alternative vaccinators
Vaccinate
Educate
Communicate
Prepare for all hazards
Medical countermeasure review and vaccine capabilities for the future

6. Even More Ways Forward Build community resilience
11/19/2019
Even More Ways Forward
Build community resilience
Everyone needs to have a plan, and reach out to those who are more vulnerable and need more help
Partnerships are critical
AT THE LOCAL LEVEL
Build on those we have and those we have built
Public and private sector
Clinicians and communities
New science
Academia and industry-new vaccine technologies
Operations research and supply chain science
Communication/social science
How can we harness new partnerships with the Education community and apply successes to future influenza seasons, other immunization campaigns and public health emergencies?
Huge successes with this model in states across the country.
Can we translate this model to how we think about use of childhood vaccines and future public health emergencies?
How can we engage the healthcare sector differently – move beyond employer and big-box partnerships
Connection between public health and medical communities needs to be strengthened - they are part of each other – they aren’t separate.
Improve the number of private physicians both willing to recommend vaccination and then actually have the capacity to administer
Improve vaccine use by OB/GYNs
As broader and more integrated health care coalitions are fully developed with primary care, emergency care, and public health partners, these will serve as a strong foundation which will support scalable medical surge capabilities at the community, State, and regional levels.

7. Conclusions
The National Health Security Strategy inextricably links our nation’s preparedness and immunization
Requires capabilities beginning with surveillance, and ending with immunization
Aligning immunization and preparedness missions makes good, day-to-day sense for both