Universal Influenza Vaccine

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Universal Influenza Vaccine

• How To Make It Work
• A State Perspective
• Beth Rowe-West, Head
• Immunization Branch
• Division of Public Health
• North Carolina DHHS
• Immediate Past Chair, AIM

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Why We Should Expand the Recommendation

• Reduction in morbidity and mortality
• Decrease transmission in a major reservoir
  children
• Potential to achieve some level of herd immunity
  annually
• Improved ability to respond to pandemic
• Lessen confusion about priority groups
• Sends a message that flu is a serious health
  threat
• Potential to expand and stabilize the flu vaccine
  marketplace

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Challenges

• Public/private partnership
• National, state and local
• Affordability
• Service delivery to all socio-economic
  populations
• Collecting data from non-traditional health care
  sites
• Misperceptions about Flu vaccine

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Ten Ingredients for Success

1. Stable vaccine market
2. Expansion of 317 funding
3. Support from health care providers
4. Effective public awareness campaign
5. Dispelling the myths
6. No thimerosal
7. Enhance surveillance
8. Influence supply driver
9. Phased-in approach
10. Effective public/private partnership

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1. Stable vaccine market

• Adequate supply
• Practical distribution
• Willingness to achieve high profit margin from
  increase product sales as opposed to higher
  cost/dose

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2. Expansion of 317 program (vaccine and
operations)

• Relies on currently successful infrastructure of
  state immunization programs
• Allows for streamlined service delivery
• Eliminates cost as a barrier
• Provides support to local agencies
• Funds public awareness efforts
• Supports state and local efforts

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3. Support from healthcare providers

• Exemplify
• Educate
• Promote
• Vaccinate

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4. Effective Public Awareness Campaign

• National primetime PSAs
• Statewide media coverage
• Local media coverage
• Multiple translations/media outlets

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5. Dispel the Myths

• Flu vaccine causes flu
• Duke Clinical Research Institute Reason for
  refusal for up to 48 of patients
• Flu vaccine not effective
• Duke Clinical Research Institute Reason for
  refusal for 26 of patients
• Flu vaccine only works when given in
  OctoberNovember at the latest!
• I hardly ever get the flubesides, flu is not
  all that serious.
• Improving Rates of Influenza Immunization in
  Asthma Patients A Duke Primary Care Research
  Consortium Study

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Top Reasons for Not Receiving Flu Vaccine
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Administrative Data Univariate Analysis of Age

• Nonlinear in both years
• High in young children, decrease steadily until
  age 25, then increase steadily, reaching highest
  level at age 70
• P0.001, logistic regression with 3 slopes
• Ranges 1-26, 27-73, and 74 and older

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6. Eliminate Thimerosal

• PERIOD

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7. Enhanced Surveillance Using Registries

• Documentation in registries essential
• Second dose
• Pandemic
• Tracking
• Mapping (learning lessons from Katrina)
• Streamlined data collection
• Data exchanges desirable
• Aggregate data for reporting
• Patient specific for billing purposes (admin fee)
• Scanable devices needed for mass clinics

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8. Influence Supply Driver

• Recommendation vs historical demand

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9. Phased in Approach

• If adequate funding not immediately available,
  consider phased-in approach (similar to earlier
  hepatitis B recommendations)
• Currently, high risk groups recommended
• latest addition of 6-24 month olds a potential
  beginning of phased-in approach
• Next step primary school age children?
  (grades k-5)

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10. Effective Public/Private Partnerships

• National Leadership, Education
• State Coordination, Education
• Local Collaboration, Education, Vaccination

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National Leadership, Education

• AMA
• AAP
• DOE
• Pharmaceutical companies
• up front vaccine purchase cost
• ACIP
• CMS Creation of Vaccine for Adults Program -
  funding reallocation to NIP from
  Medicaid/Medicare to avoid
• Media Outlets
• Others

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State Coordination, Education

• Other state agencies
• Regional planning teams
• Support from Governor, General Assembly
• Medical and nursing schools
• Insurers
• State AAP, AMA
• Hospital Association (vaccinate at exit points
  for both inpatient and outpatient, grand rounds
  participation
• Retired nurses network
• Hot Line/Help Desk/Flu-finder
• Media Outlets

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Local Collaboration, Education and Administration

• Businesses
• Work site administration
• Retail vaccination sites
• Schools, colleges/universities
• Healthcare network
• Home health agencies, hospitals, SNFs
• Churches
• Expanded hours and weekends
• Expand staff or volunteer effort during flu
  vaccine season
• Outreach to populations without transportation
• Senior Centers
• Autodialers
• Some mass clinics necessary
• Drive through clinics
• Crowd control

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Strategies

• Multiple administration sites needed to vaccinate
  large number of individuals within short
  timeframe
• Administration fees (and 3rd party reimbursement)
  should be significant enough to be an incentive
  for the private sector, whether a health care
  provider or non-traditional sites (eg, retail
  shopping)
• Duplication of school-site initiatives to
  increase coverage among school age children
• Worksites initiatives
• Phased-in approach

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Where Do We Go From Here?

• Consider phased in approach over the next 3-5
  years, beginning with school age children. This
  should help
• Jump start a decline in flu morbidity and
  mortality
• Stabilize vaccine market
• Enhance immunization program infrastructure
• Meanwhile
• Encourage pharmaceutical companies to eliminate
  thimerosal from flu vaccine
• Significantly reduce highly prevalent patient
  misconceptions about flu vaccine.
• Significantly increase flu vaccine coverage rates
  among healthcare workers.
• Educate the public about the necessity of flu
  vaccine.
• Develop VFA program
• Plan for expansion

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Questions?