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State to designate providers to give H1N1 vaccines Aug 11 09

States to designate providers to give H1N1 vaccines

Robert Roos News Editor

Aug 10, 2009 (CIDRAP News) – State health departments will decide which providers will administer the pandemic H1N1 influenza vaccine this fall, and a single company will be the distributor for all the doses, it was announced today.

McKesson Corp., based in San Francisco, announced it will be the central distributor of H1N1 vaccines under a contract with the Centers for Disease Control and Prevention (CDC). McKesson currently distributes vaccines under the CDC’s Vaccines for Children (VFC) program.

"McKesson’s role will be to distribute the vaccine to sites designated by state health departments across the country," the company said in a press release. "Each state will designate the providers who will receive and administer the vaccine."

That’s different from how seasonal flu vaccines are handled, noted Jim Blumenstock, chief program officer for public health practice at the Association of State and Territorial Health Officials in Washington, DC.

"This is a government-controlled program, so it’ll be the state agencies working with local partners and the CDC that will make the determination as to where the public will be able to get vaccine," Blumenstock said. "This is not like your seasonal flu [vaccination] program where healthcare providers decide whether or not they want to do it and then submit private orders."

Meanwhile, the CDC released a statement today saying that using a single vaccine distributor will be more efficient than having vaccine manufacturers ship doses directly to customers. The agency also repeated previous government predictions that vaccine shipments are likely to begin about mid-October, though a late September start for shipments remains a possibility. It said each person will probably need two doses.

"One of the key benefits of using a centralized, third-party distributor to support H1N1 vaccine distribution is that it allows distribution of doses to a much larger number of provider sites than would be feasible with direct manufacturer distribution," the CDC said in a question-and-answer document about H1N1 vaccination planning.

The McKesson statement said, "The H1N1 vaccine distribution effort will include the centralized distribution of the H1N1 flu vaccine to as many as 90,000 sites across the country, making it the largest public health initiative in the CDC’s history."

The company said it distributes 80 million doses of vaccine to more than 40,000 providers each year under the VFC program, which serves uninsured and Medicaid-eligible children and children of Native Americans and Alaska natives.

The CDC said the same distribution process used in the VFC program will be harnessed for the H1N1 effort, but it will be "substantially enhanced" to increase capacity. Vaccine providers are likely to include a mix of public health and private sector sites.

Blumenstock said state health departments would probably consider requests from large employers who want vaccine for their workers, but he noted that the general population of healthy adults is not among the groups targeted for the first doses that become available. The CDC recently announced that the initial target groups for immunization are pregnant women, close contacts of babies under 6 months old, healthcare and emergency medical workers, young people from ages 6 months through 24 years, and nonelderly adults with chronic health conditions.

State health departments are currently planning how to designate providers, Blumenstock said. "The CDC has drafted a provider agreement that will lay out terms and conditions for participation, so everyone going into this will know what’s expected of a provider" and what support the states will provide, he said.

The federal government will pay for the vaccine and related supplies, including needles, syringes, and sharps containers, the CDC noted.

Funds for administering the vaccines will have to come from elsewhere, and today the CDC said a trade association of health insurance companies stated that its members will cover the administration costs for private-sector providers.

The group America’s Health Insurance Plans (AHIP) told the CDC, "Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings . . . and in nontraditional settings, where contracts with insurers have been established."

The CDC also said today that vaccination planners should consider two scenarios for vaccine availability. The first possibility is that about 120 million doses will be released starting in mid-October and continuing over 4 weeks, followed by 80 million doses per month after that. The second scenario envisions about 20 million doses being released starting in late September, followed by 20 million doses a week thereafter.

On other points, the CDC said:

  • Though it is uncertain until clinical trial results are in, planners should assume that each person will need two doses of vaccine.
  • Practical considerations will make it difficult to ensure that any given person’s first and second doses of vaccine will be the same product (five manufacturers are supplying vaccine).
  • The CDC’s goal is to have enough preservative-free (ie, thimerosal-free) vaccine available for young children and pregnant women, in single-dose vials or nasal sprayers.
  • It is expected that seasonal flu vaccine and the pandemic vaccine may be administered together.
  • There will be no federal requirement for vaccinators to require people to provide proof of priority-group status, such as a doctor’s note documenting pregnancy or risk status.
  • The CDC is not currently recommending pneumococcal vaccine to anyone not already covered by such a recommendation. Pneumococcal vaccination has been suggested as a way to reduce the risk of secondary bacterial pneumonia in H1N1 flu patients.