Implementation of a Prioritization Schema for Allocation of Limited H1N1 Vaccine

Background:

In June of 2009 H1N1 influenza A was declared a pandemic by the World Health Organization and CDC/ACIP published H1N1 influenza A vaccination recommendations in the Fall.  The vaccine became available in the Fall of 2009, however insufficient supply was available to California healthcare facilities. Due to receipt of a fraction of the amount of vaccine requested, the need for a schema for allocation to distribute the vaccine to both healthcare workers, as well as patients, at Stanford Hospital & Clinics (SHC) and Lucille Packard Children's Hospital (LPCH) emerged.

Objective:

To implement a prioritization schema for allocation of limited H1N1 vaccine to patients and healthcare providers in an academic medical center using an ethical framework.

Methods:

A Clinical Oversight Steering Team, consisting of physician, nurse and administrative leaders across both medical centers, was developed to provide leadership, coordination, and oversight for allocation of the H1N1 vaccine.  The challenge to develop the prioritization schema was complex given the two distinct organizations, two patient populations (adult, pediatric) which shared a common Occupational Health department. 

This team consulted with the medical centers' Ethics Committee to develop guiding principles and a risk/benefit analysis for providing vaccine to healthcare workers versus patients.  This discussion enabled the team to develop and implement a simple tiered schema for allocation.

Results:

The determined priority for vaccine allocation is presented in Table A.  Using this 3-tiered prioritization schema, a total of 8200 were administered in Tier I and 6000 doses in Tier II.  Before beginning vaccination of Tier III, sufficient vaccine was received from the State of California which allowed us to vaccinate all remaining healthcare workers and patients.  Although healthcare workers and patients did complain about the general lack of vaccine, no healthcare worker in either medical center voiced concerns about the tiered schema.

Conclusions:

This prioritized allocation schema proved successful in allocating a limited supply of H1N1 vaccine.  Developing a common Clinical Oversight Steering Committee was essential given the added complexity of the two healthcare organizations, and the absolute need to develop a common schema.  Consulting with the organization's Ethics Committee proved essential to this process to ensure fair and just vaccine allocation.  This allocation process serves as a model for future allocation of scarce patient care resources.