Brother, Can You Spare a Dose (of H1N1 Vaccine)? Flexibility is Key to Efficient Distribution

 Background: In many states, Public Health only distributes vaccine for the Vaccines for Children Program. The distribution of 2009 H1N1 vaccine required a novel system to address the needs of all potential public and private sector immunization providers. The Tennessee [TN] Department of Health [TDH] needed to create a flexible process, given the unpredictable availability of 9 different products from 5 manufacturers. All vaccines shipped in 100-dose boxes of multidose vials [MDV] or prefilled syringes [PFS].
 Objective: Describe TN’s vaccine distribution process.

 Methods: On August 5, pre-registration via TN’s immunization registry web portal was opened to all health care facilities [Fs] interested in administering H1N1 vaccine.  During pre-registration, Fs selected their facility type (a proxy for population served), estimated the vaccine needed and completed shipping and contact information.  TDH issued a Pandemic PIN and created a shipping profile for all Fs eligible for direct shipping (those requesting 1 or more 100-dose boxes). Fs requesting < 100 doses were assisted by local public health.  Using their PIN, Fs electronically signed the Federal H1N1 Vaccine Provider Agreement and placed initial orders through an online survey tool.  To allow flexibility in filling orders, Fs ordered injectable vaccine according to the ages of intended recipients (not by brand) and could specify MDV or PFS or accept either. Live attenuated vaccine was ordered specifically.  Following the online order, a verification email was sent to confirm an accurate order. MS Access queries were created to rank Fs according to facility type for each vaccine formulation. Each formulation could have different priority recipients. For example, acute care hospitals were top priority to receive most formulations first, but OBGYN facilities were prioritized above them for the first available PFSs. Each allocation to the state was first divided according to population among the 13 public health regions, then distributed among providers within each region. Within 24 hours of the allocation, most orders were transmitted to CDC and arrived to providers 48 hours later. TDH created an email shipping notification system to alert Fs of a shipment.  Macros within MS Excel were created to update the order database to accurately reflect orders filled and maintain maximum flexibility in choosing formulations to fill F order balances. Fs reported the weekly # of doses administered through a brief online survey.     
 Results:  To date, 1,594 Fs have pre-registered for H1N1 vaccine and TN has distributed about 1,000,000 doses. Distribution will continue until demand is saturated. Although just 2% of the US population, TN has accounted for 4-6% of weekly doses reported administered in the US.

 Conclusions: With limited time and resources we implemented an efficient process for vaccine distribution to public and private sectors in TN.