1. Pandemic Influenza Vaccine Distribution Selected Updates Pandemic Influenza Vaccine: Doses Administered and Safety Training Conference Toscha Stanley, MHSA Immunization Services Division Centers for Disease Control and Prevention (CDC) August 21, 2008

2. Vaccination periods Five vaccination periods (take into account both timing and supply) –Preparation period –Pre-pandemic influenza vaccination period –Manufacturing period –Early pandemic influenza vaccination period –Later pandemic influenza vaccination period

3. Vaccine distribution Initial demand expected to exceed supply –When (demand >>> supply): allocation “push” model –When (demand > supply): may transition to “pull” model Vaccine distribution will be monitored via CDC’s FluFinder States will be able to access FluFinder data for their individual state through the CDC secure data network

4. Direct distribution Manufacturer ships vaccine to states using its established distribution channels (commercial shipper or 3 rd party distributor) May involve single or multiple manufacturers depending on the current state of domestic manufacturing capacity

5. Ship-to site 1 (50%) POD Ship-to site 2 (25%) POD Ship-to site 3 (25%) POD State A (4% of U.S. supply) Ship-to site 1 (60%) POD Ship-to site 2 (30%) POD Ship-to site 3 (10%) POD State B (2% of U.S. supply) Vaccine manufacturer B 3 rd party distributor Vaccine manufacturer A Direct distribution: Pre-pandemic influenza vaccine distribution with multiple manufacturers jointly supplying states CDC and HHS Needle/syringe manufacturer

6. Ship-to site 1 (50%) POD Ship-to site 2 (25%) POD Ship-to site 3 (25%) POD State A (4% of U.S. supply) Ship-to site 1 (60%) POD Ship-to site 2 (30%) POD Ship-to site 3 (10%) POD State B (2% of U.S. supply) Vaccine manufacturer A Direct distribution: Pandemic influenza vaccine distribution with a single manufacturer CDC and HHS Needle/syringe manufacturer

7. Operations at the state level State-designated ship-to sites must be capable of: –Receiving –Storing –Securing –Repackaging –Allocating to PODs –Follow-on distribution to PODs Allocation, distribution, and administration within a state will be a state and local function

8. Ship-to sites Total # of Pre-pandemic vax ship-to sites = 623 Total # of Pandemic vax ship-to sites = 976 1 site2-10 sites>10 sites Pre-Pandemic 43 9 10 Pandemic 38 8 16 Federal ship-to sites

9. Single central ship-to site POD 1 POD 2 POD 3 State X: Single central ship-to site with direct shipment to PODs Vaccine, adjuvant, needles and syringes POD 4 POD 5

10. Single Central ship-to site POD 1 POD 2 POD 3 Vaccine manufacturer or distributor POD 4 POD 5 Regional sub-ship-to site #1 Regional Sub-ship-to site #2 State Z: Single ship-to site with regional sub-ship-to sites within the state

11. Ship-to site #1 POD 1 POD 2 POD 3 POD 4 POD 5 Ship-to site #2 Ship-to site #3 State Y: Multiple ship-to sites with direct shipment to PODs Vaccine, adjuvant, needles and syringes

12. The findings and conclusions in this presentation have not been formally disseminated by CDC and should not be construed to represent any agency determination or policy.

13. Extra Slides

14. Ship-to site 1 (50%) POD Ship-to site 2 (25%) POD Ship-to site 3 (25%) POD State A (4% of U.S. supply) Ship-to site 1 (60%) POD Ship-to site 2 (30%) POD Ship-to site 3 (10%) POD State B (2% of U.S. supply) Vaccine manufacturer B Centralized distribution: Multiple manufacturers and multiple products Vaccine manufacturer A Central distributor CDC and HHS Needle/syringe manufacturer Centralized Distribution Option