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

Background: Public Health[PH] generally only distributes vaccine for the Vaccines for Children Program.  Distribution of the 2009 H1N1 vaccine required a novel system to address the needs of all potential public and private sector immunization providers. The Tennessee Department of Health[TDH] required a flexible distribution process, given the unpredictable availability of 9 different products.

Setting: Tennessee public and private health settings.

Population: Tennessee residents.

Project Description: On August 5, pre-registration via Tennessee’s immunization registry web portal opened to all healthcare facilities.  Facilities responded by providing: facility type (population served), estimated vaccine needed and shipping/contact information.  TDH issued Pandemic PINs and created profiles for facilities eligible for direct shipping (local PH assisted facilities requesting <100 doses).  Facilities electronically signed the Federal H1N1 Vaccine Provider Agreement and placed orders via online survey tools.  To allow flexibility in filling orders, facilities ordered injectable vaccine by ages of intended recipients  and could specify Multidose vials or Prefilled Syringes or either. Live-attenuated vaccine was ordered specifically. Microsoft Access queries ranked facilities by facility type for each vaccine formulation. Allocations were divided according to population among Tennessee’s PH regions and distributed among providers. Within 24 hours of the allocation, most orders were transmitted to CDC and arrived to providers within 48 hours. An email shipping notification system alerted facilities of a shipment.  Macros within Microsoft Excel were created to update the order database to reflect orders filled and maintain maximum flexibility in choosing formulations to fill orders.

Results/Lessons Learned:  THD has distributed >2,425,700 doses to 1,636 pre-registered facilities. Distribution will continue until demand is saturated. Before ceasing reporting of doses administered, Tennessee accounted for 3.22% of weekly doses administered, although representing only 2% of the US population.  With limited time and resources we implemented a successful process for vaccine distribution to public and private sectors.