Standing up in a Crowd: Implementation of the H1N1 Vaccine Program in Washington State

Background: With the H1N1 pandemic starting in April 2009, Washington State engaged in a process of standing up a complex statewide vaccination program for people of all ages in an extremely short time period.  Collaboration was required between emergency preparedness, epidemiology and immunization staff at the state and local level. Delays in vaccine availability, the integration of the commercial sector with public health, and autonomous local health authority in decision making created a challenging environment for implementation.

Setting: Washington State

Population: State and local health departments, health care providers, retail organizations, residents of Washington.

Project Description: Washington State Department of Health Immunization Program CHILD Profile, Public Health Emergency Preparedness, and Registry staff worked together with many stakeholders, including state agencies, local public health, the provider community and commercial vaccinators to stand-up and operate a statewide vaccination program. All aspects of implementation were analyzed at the systems and provider level in order to create a system that would work for all provider types. Practice guidelines, support materials and tools for registering, enrolling, and reporting requirements of the H1N1 vaccination effort were developed. Communication was facilitated between multiple stakeholders via web-casts, conference calls, and e-mail distribution lists. Materials were posted to the web-site for easy access. Pre-registration and reporting were conducted on-line. Doses administered reporting was facilitated through the statewide immunization registry. Customized tools were created for multisite organizations, community vaccinators and pharmacy organizations.  

Results/Lessons Learned: One size does not fit all - strategies needed to fit the business models of public health, private providers and commercial vaccinators. 2,500 providers participated in the H1N1 vaccination effort. Misunderstandings occurred, and messages were refined throughout the process. A complex system can quickly mobilize a community response and get people vaccinated. Emergency preparedness response and immunization program staff can successfully implement the H1N1 program.