University of Michigan Health System Tracking and Evaluation of H1N1 Vaccine Implementation by Immunization Grantees Sarah Clark Child Health Evaluation.

University of MichiganHealth System

Tracking and Evaluation of H1N1 Vaccine Implementation

by Immunization Grantees

Sarah ClarkChild Health Evaluation and Research Unit (CHEAR)

University of Michigan

Association of Immunization ManagersJanuary 22, 2010


Background

• H1N1 vaccine implementation was characterized by:– Federal guidance and structure– Substantial flexibility for implementation at

the program level– Known unknowns and unknown unknowns


Purpose

• To collect situational awareness data on H1N1 vaccine implementation– Collaborative approach– Useful in the short term

• To utilize situational awareness data in evaluating H1N1 vaccine implementation– Lessons learned based on experiences


Methods – Phase 1

• Build consensus with partners– AIM, ASTHO, CDC

• Determine data sharing mechanisms– High priority for program officials to receive

data in a timely fashion– Concern about data becoming public

• Identify topics for data collection


Data Collection – Phase 1

• Data collection from immunization program managers, their designee, and/or H1N1 vaccine implementation lead

• 50 state and 4 metropolitan areas

• Mix of telephone and email contacts:– Balancing concerns about time required for

participation with complexity of questions and responses


Data Collection – Phase 1

• October 2, 2009 – ?– 16 weeks (and counting)

• Fantastic participation by program officials

• The “UM All-Stars”– CO, CT, FL, KS, LA, NC, ND, OH, RI


Data Dissemination

• to AIM membership via email from AIM and members-only website

• to ASTHO membership via email from ASTHO

• to CDC officials responsible for vaccine implementation*


Impressions #1

There was substantial variation across programs from the outset.

In other words, programs utilized the flexibility they were given.


Results – Week of 10/2/09

• Target populations for initial LAIV doses– healthcare workers (42)– Children 24-48 months (32)– Children 5-9 years (26)– Children 10-18 years (22)– Caregivers of young infants (4)



• Target settings for initial LAIV doses– hospitals (29)– local public health (29)– private VFC providers (16)– private non-VFC (H1N1 only) providers (6)– community health centers (3)– Indian Health Service (3)


Impressions #2

Program officials were asked to make complex decisions, often in a completely new context.



• Allocation Strategies– Focus on large sites with priority populations (3)– Every provider gets something (7)– Percentage of total based on estimated priority

patients (4)– Random selection of providers (1)– Match vaccine presentation with provider type (6)– Done by local public health partners (16)


Impressions #3

The more things changed, the more things changed.


ACIP Recommendation

Initial target groups:• Pregnant women• Caregivers of infants <6 months• Health care workers• Children 6 months - 24 years • Adults 25-64 years with high-risk conditions


ACIP Recommendation

Subset of target groups (priority if vaccine supply is inadequate):

• Pregnant women• Caregivers of infants <6 months• Health care workers w/direct contact• Children 6 months - 4 years • Children 5-18 years with high-risk conditions


• Unexpected decreases in vaccine projections prompted programs to consider moving to priority groups.

• Data on H1N1 disease impact cross different risk groups was just beginning to emerge.


Impressions #4

Program officials balanced competing demands from multiple levels.


We hear you!

“It would be nice if CDC would close down the rhetoric so we can get vaccine out and focus on what’s happening in our state. You can put that in BOLD print!”


We hear you!

“That’s a really good idea…But it doesn’t really matter what I think. Nobody listens to me anyway. Even if we make a decision, they’re just going to change it at the last minute anyway.”


We hear you!

“We’ve been doing this straightforwardly and transparently…The media have their own way of making it interesting.”


We hear you!

“We strive for generalized consensus with all the counties; we agree on something. And then the next day, they just all do whatever they want anyway. It’s insane.”


We hear you!

“65 and over is saying, Hey look at me! I have a condition!”


We hear you!

“I’m deluged with call from providers, and strange requests on top of that—like the guy who was about to get a hernia operation but needed the vaccine first.”


Evaluation

Goals of Phase 2:• Document objectives, decisions, considerations,

strategies across programs• Incorporate what was known at the time• Evaluate success in light of program-specific

objectives and strategies• Synthesize information to produce “lessons

learned” that will inform the future


Potential Evaluation Topics

Decision-making • Core principles and objectives• Involvement of other agencies/entities• Challenges of local control• Information sources / adequacy • If I had it to do over…



New relationships • Challenges/successes with new provider groups • School vaccination• Opportunity for ongoing collaborations



Other areas • Obtaining and using data • Technical systems• Strategies/programs to maintain for future (and

how to fund them)


Appreciation

• Anne Cowan, Brian Macilvain, Gary Freed• Claire Hannan, Kaitlyn Wells• Anna Buchanon, Kathy Talkington• Pascale Wortley & team

But most of all…• AIM members


University of Michigan Health System Tracking and Evaluation of H1N1 Vaccine Implementation by Immunization Grantees Sarah Clark Child Health Evaluation.

Documents

vaccine supply

vaccine projections

priority groups

situational awareness

match vaccine presentation

priority populations

immunization program

target populations