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Story from the Field

Name of Health Department/Agency: Wisconsin Department of Health
State: WI
Date Added: 03/10/2010
Themes: Vaccine Planning and Administration
Issue Summary: Decision-making Process to Expand H1N1 Vaccination Beyond ACIP Target Groups
Description of Issue(s):
Wisconsin’s H1N1 vaccination program is a joint effort between the immunization and preparedness sections of the state health department. This partnership has been useful since the state started its vaccination program in mid-October. At the onset of planning, state officials intended to work with the full ACIP recommendations. However, because initial supplies were too limited to meet the demand, state officials decided to prioritize vaccine for the ACIP priority subgroups (starting October 21).
Actions taken to address the issue(s): On November 19, vaccination efforts were expanded to include individuals aged 19-64 with chronic medical conditions. This expansion was considered to be especially important due to the higher hospitalization rates in this group. Once supplies increased, Wisconsin expanded their prioritization to include all ACIP target groups.

Wisconsin sent two surveys one to public providers (e.g. local health departments) and another to private providers. The provider surveys asked the following questions

  • Did the provider receive some of their vaccine?
  • What region of the state do they serve?
  • Were they holding onto their vaccine for any reason?
  • How many (number) of doses have they administered to date?
  • Do they have sufficient vaccine on hand to hold clinics?
  • For public providers, what efforts have they done to reach members of high risk subgroups other than holding community-based clinics? (For example, have you been targeting pregnant women via WIC programs, prenatal visits, office visits, school-located vaccination clinics?)
  • Did the providers feel their current supply of vaccine provided them with enough vaccine to cover the full ACIP list of target groups?
  • When did they think they would be able to start immunizing those groups?

Surprisingly local health departments felt they had enough vaccine to open their clinics to additional target groups. The private providers were not as confident that they had sufficient supplies to do this. At this time, vaccine was allocated 50% to public providers and 50% to private providers. Wisconsin decided to push a larger proportion of the allocation to private providers to vaccinate their populations (e.g. ACIP subgroups) before expanding their campaign to the target groups.

Outcomes that resulted from actions taken: Wisconsin is considering the same factors in expanding the campaign from target groups to the general public (e.g. all eligible populations). Anecdotally, Wisconsin is hearing from providers that demand is beginning to wane and probably will drop off after Christmas (much as demand for seasonal vaccine drops). Wisconsin is considering expanding to the general population around this time, and they are currently in contact with their providers who still feel they do not have sufficient quantities to meet their demand. The key question is when to pull the trigger. Wisconsin used the survey and was satisfied with the level of response from both public and private providers.

Using a provider survey was an effective method for Wisconsin to assess when to expand vaccination to additional groups.

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