As school doors opened across the country in the past few weeks, the drumbeat of public concern over the H1N1 flu and its prevention began rising in pitch. While manufacturers have been busily producing the vaccine, and state and federal public health officials making extensive preparations, the fact is that the actual administration of vaccine to nearly 160 million Americans will proceed in a novel way, and under a compressed time frame (technically, flu season has already started, but the vaccine won’t be available until October).
Last spring, seeing the rapid spread of the flu, the Centers for Disease Control opted to purchase all available capacity for the vaccine. In the summer, under existing emergency-planning procedures, it chose McKesson as the primary distributor of the vaccine. Manufacturers will ship to four DCs of McKesson, which had already been the designated distributor for CDC’s Vaccines for Children program.
Thereafter, a new process begins. Each state’s public health authority will designate a group of distributors and healthcare providers; McKesson will ship to them, and any secondary distribution will occur within each state. McKesson normally ships to around 40,000 sites for the Vaccines for Children program; H1N1 could involve 90,000 sites.
All this would seem to work well provided that the vaccine distribution more or less follows the pattern of conventional (seasonal) flu distribution. CDC has established a priority list, led by young children and the elderly, for receiving vaccine. If there is a rush to receive vaccine as soon as possible, the system could be overwhelmed, and so public health authorities will try to keep the population calm as the distribution (which will continue until early next year) progresses. In early September, SDI Health (Plymouth Meeting, PA) reported that its pharmacy surveys showed that over 477,000 seasonal-flu vaccinations have been performed—up 237% over the year before.
Vaccines plus drugs
H1N1 vaccine is but one of three flu season distributions: seasonal vaccine will also be handled, as will antiviral drugs (Roche’s Tamiflu and GSK’s Relenza). Many distributors (including Cardinal Health and AmerisourceBergen) will handle these, as well as masks, syringes and related equipment.
All of this will be a “very challenging situation,” says Pat Schmidt, president of Temecula, CA, distributor FFF Enterprises, which also operates a vaccine administration unit called VaxAmerica. “This will be a new way to access vaccines, and there’s a lot of uncertainty around it.”
CDC has led numerous coordination meetings over the past several months, as has the Healthcare Distribution Management Assn. and RxResponse, the coordinating council for disaster planning that includes healthcare providers and manufacturers. “One result of our discussions with CDC officials is the development of a system for sharing information about the supply of antivirals,” says Jeff Van Ness, communications director at HDMA. “So we’ve developed a simple ‘green light, yellow light, red light’ system, based on voluntary reporting from distributors, to make information about supply easy to understand.” PC