Universal Influenza Vaccine

1. 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

2. 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

3. 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

4. Ten Ingredients for Success • Stable vaccine market • Expansion of 317 funding • Support from health care providers • Effective public awareness campaign • Dispelling the myths • No thimerosal • Enhance surveillance • Influence supply driver • Phased-in approach • Effective public/private partnership

5. 1. Stable vaccine market • Adequate supply • Practical distribution • Willingness to achieve high profit margin from increase product sales as opposed to higher cost/dose

6. 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

7. 3. Support from healthcare providers • Exemplify • Educate • Promote • Vaccinate

8. 4. Effective Public Awareness Campaign • National primetime PSAs • Statewide media coverage • Local media coverage • Multiple translations/media outlets

9. 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 October…November at the latest!’ • ‘I hardly ever get the flu…besides, flu is not all that serious.’ *Improving Rates of Influenza Immunization in Asthma Patients: A Duke Primary Care Research Consortium Study

10. Top Reasons for Not Receiving Flu Vaccine Improving Rates of Influenza Immunization in Asthma Patients: A Duke Primary Care Research Consortium Study

11. 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 • P=0.001, logistic regression with 3 slopes • Ranges 1-26, 27-73, and 74 and older * Improving Rates of Influenza Immunization in Asthma Patients: A Duke Primary Care Research Consortium Study

12. PERIOD 6. Eliminate Thimerosal

13. 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

14. 8. Influence Supply Driver Recommendation vs historical demand

15. 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)

16. 10. Effective Public/Private Partnerships • National: Leadership, Education • State: Coordination, Education • Local: Collaboration, Education, Vaccination

17. 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

18. 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

19. 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

20. 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

21. 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

22. Questions?