Expanded Influenza
Vaccination
Recommendations:
Developing an Implementation
Strategy
Litjen (L.J) Tan, MS, PhD
American Medical Association
Co-Chair, National Influenza Vaccine
Summit
Disclaimer…
The opinions expressed in this presentation
are solely those of the presenter and do
not necessarily represent the official
position of the American Medical
Association
The Current Influenza Vaccination
Environment: An Ongoing Paradigm
Shift
 For
providers and for the public
 Crisis of shortage/delays to a crisis of
surplus

27 million doses not distributed in 2007-08
season
 To
reduce mortality and morbidity,
influenza immunization rates must
increase by utilizing the entire season

BUT it’s not about having more time to
vaccinate the SAME people
The Changing Paradigm…
 The
traditional paradigm of influenza
vaccination is no longer a valid model!

Vaccine delivery complete by
September/October
• Myth: Differences in delivery is reflection of
distribution inequities

Immunization should be complete by
November
• And it’s not simply about telling providers to
vaccinate throughout the season…
The Current Vaccine Supply and
Distribution

Vaccine delivery complete by
September/October


As manufacturers make more influenza vaccine
doses, vaccine will arrive over time through
December and beyond, rather than in a short burst in
October
Nature of vaccine production and lot approval dictates
that production lots of vaccine must be released over
time
• Some years will be better/worse than others
• If we are vaccinating all recommended populations, we need
to have vaccine still available in January!
The Current Vaccine Supply and
Distribution

Improved vaccine distribution on ground by
improved vaccine production



More manufacturers
More manufacturing capacity
BUT Distribution differences will always exist
• Vaccine distribution important to all
• ‘Me first’ serves little purpose-there will always be some
getting vaccine before others as long as all annual vaccine is
not available well before the season

Increased vaccine production requires vaccine
distribution to occur through entire influenza
season
Full Season Immunization Is One
Way To Improve Rates

Health care providers are hearing the expanded
season message but are not equating it to
immunizing MORE ACIP-recommended people.
 Current influenza immunization rates are below
HP 2010 goals - significant morbidity, mortality,
and economic costs
 Opportunities exist to immunize more patients
 Vaccination is still effective well beyond
December
The 18-years And Under
Recommendation

Implementation will be challenging



In 2008-09 the number of new vaccinees due to the 5-18
recommendation may be only about 8 million vaccinees1
May place a burden on the traditional pediatric medical
home
Innovative ways to reach these children must be
considered1





Complementary locations such as schools, with collaboration
with the traditional pediatric provider
Use epidemiologic and uptake data to target vaccination?
What about the timing of influenza vaccination of school aged
children (some or ‘all’)?
Would it be realistic to split the children into an early season
group and a later group? When which?
Would second week in Sept. be too early to start the first group?
What group?
1Gary
Euler, National Influenza Vaccine Summit, 2008
Expanded Recommendations May Provide More
Opportunities For The Medical Home
39 Million (69%) 5 through 18 year-olds had one or more visits to
a primary care physician during the 2007 influenza season1
Patient Visits
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
Sep
Oct
5 to 10 Years of Age
Nov
D ec
11 to 12 Years of Age
Jan
F eb
13 to 18 Years of Age
(As of July 31, 2007 the US Census Population Estimate for the 5-18 year age group is
57,692,196)2
1. Surveillance Data, Inc. (SDI), February 2008. Ad Hoc Report on Patients Aged 5 to 18 Years, January to December 2007. Based on nationally
projected data from physician office electronic medical claims submitted on CMS-1500 forms for third-party reimbursement. 2. Claritas, Inc., a division
of The Nielsen Company, 2007 U.S. Population Estimates by Age.
Goals of Today’s Meeting
 Bring
together a broad range of
stakeholders to identify
coordinated next steps for
implementing universal influenza
vaccination recommendations

So let us know who is missing from
today’s meeting…
Objectives for Today’s
Meeting

Develop a multi-sectoral public health national
strategy to implement the expanded influenza
vaccination recommendations
 Identify creative and innovative implementation
ideas
 Identify the barriers to full and immediate
implementation of expanded efforts on influenza
vaccination and draft strategies to overcome
these barriers
Operating Protocol…

Day One


Day Two



Large, then small group sessions to identify areas
of agreement and disagreement, priority, and
action.
Provide a forum for all participants to report back
to the larger group on the first day’s small-group
discussions/results
Expand knowledge of the issues
Identify specific commitments/actions that
groups/individuals make to move forward
implementation of the recommendation
Fair Game…
 Financing,
policy, and legislation
 Public and provider education
 Industry accountability and product
control
 Alternatives to the medical home –
implications/challenges/opportunities
 Strategic partnerships and building and
supporting capacity for implementation
Anticipated Products…

Meeting proceedings to guide the
development of a national strategy and to
identify areas in which further discussion
among partners is warranted


The draft strategy will be shared with attendees for
feedback and endorsement. (August 2008)
Publication of a special proceedings
document that describes the meetings and
the national strategy. (September/October
2008)
Small Group Breakouts

Workgroup One – School Settings



Workgroup Two – Healthcare and Other
Settings



Facilitator: Harry Hull, MD
Note-taker: Lilly Kan, MPH
Facilitator: Mitch Rothholz, RPh, MBA
Note-taker: Cindy Phillips, MSW, MPH; Samantha
Austin
Workgroup Three – Supply, Distribution, and
Financing


Facilitator: Anna DeBlois Buchanan, MPH
Note-taker: James Ransom, MPH