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Story from the Field

Name of Health Department/Agency: Alaska Department of Health and Social Services
State: AK
Date Added: 03/10/2010
Themes: Vaccine Planning and Administration
Issue Summary: Expanding H1N1 Vaccination Beyond ACIP Target Groups
Description of Issue(s):
Due to challenges in distributing vaccine to some of Alaska's more remote locations, the state maintains its own depot, so that the State Health Department can control proper storage and handling vaccine being shipped to local jurisdictions. This also allows the state to allocate and distribute small amounts of vaccine to hard-to-reach populations.
At the onset of the program, officials intended to distribute vaccine to various parts of the state on a strictly pro rata basis. However, they had to change their approach based on the formulations of the vaccine that were initially available. For example, when preservative-free TIV was first available, the health department targeted it to obstetricians, focusing on pregnant women and other at-risk groups.
State officials discussed expanding the program to general population group members in mid-November about three weeks prior to their expansion date. Some individual providers encouraged expansion because they indicated they had administered all of the vaccine they could until Alaska opened the program further. Also, because health care in some parts of Alaska is available only on a periodic basis, the State wanted to ensure that all persons who lived in remote locations had a chance to receive vaccine at the time a provider was available in the community.
Actions taken to address the issue(s): Health officials did not want to miss opportunities to vaccinate a wider population. These officials drew upon their experience from the 2004 seasonal influenza vaccine shortage in which Alaska didn?t expand their vaccination program to the general public until the second week in January. While this may have been the ?right thing to do? in order to reach all priority group members, the health department and its partners ended up throwing away thousands of doses of vaccine because demand dropped dramatically in January. In 2004 the vaccination program lagged behind the demand and health officials did not want a repeat of this situation with H1N1 vaccine.

As a result, Alaska expanded their novel H1N1 vaccination program to all groups on December 1, 2009. Officials held a press conference November 30 to announce the new guidelines. Most providers saw a surge in demand after the announcement. While state officials had discussed the expansion during weekly partner teleconferences, some providers were ?caught unawares? by the jump in demand (especially retail pharmacies that had not been as central in the planning process as other providers).

The decision to expand has been a good one for the state. After an initial surge, demand has calmed down. Expanding the program in December has resulted in an uptake of vaccine and allowed providers to administer vaccine formulations that will expire soon. Also, by expanding the program to the general public, the state is providing secondary protection for at-risk individuals by decreasing community transmission of H1N1.

Finally, Alaska is in discussions to transition vaccine ordering, allocation, and distribution from a ?push? system (i.e., shipping vaccine to providers based on initial estimates of their needs) to a traditional ordering system (i.e., providers ordering specific types and numbers of vaccines).

To reduce opportunities for wastage, Alaska will not be distributing any vaccine during Christmas week.

Outcomes that resulted from actions taken: Communication is a central part of the effort and needs to be carefully thought through before deciding to expand the program. Health officials need to offer assistance to providers to allow them to respond to local needs.

State officials are letting providers make final decisions about whom to vaccinate. Providers who feel their supply is sufficient only to cover at-risk individuals can restrict their clinics to target populations only.

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