Allocation of Influenza Vaccines During a Pandemic

Background: Prior to the 2009 H1N1 pandemic, influenza pandemic planning focused largely on the use of temporary mass vaccination clinics, such as Points of Dispensing. In the 2009 H1N1 pandemic, temporary mass vaccination clinics played a smaller role in overall vaccination campaigns and most vaccination occurred in routine vaccination settings, such as outpatient clinics and pharmacies. In a severe pandemic, planners will need to utilize a variety of vaccination providers and settings, including temporary mass vaccination clinics and routine vaccination settings, to achieve adequate population vaccination coverage, adding complexity to local pandemic planning efforts. Planners thus need tools to understand how the vaccination capacity of each provider type (e.g. pharmacies, points of dispensing, outpatient clinics, among others), population served by each provider type, and vaccination allocation decisions to provider might affect overall capacity and desired timing to reach target vaccination coverage levels.

Methods: To meet the need to plan pre-pandemic provider outreach, we developed a spreadsheet-based model to estimate the speed (number of weeks required to reach a certain share of the population) and efficiency (whether the allocation settings result in vaccine wastage) of a given allocation strategy. The user characterizes the total target population (number of individuals, share of children in population), number of available vaccine doses, numbers of providers per type and populations they serve (children and/or adults), estimated weekly vaccination capacity for each provider, and vaccination allocation to each provider type; the user can also adjust allocations over time to each provider type.

Results: Each jurisdiction’s allocation strategy hinges on a number of different factors: target population size, number of providers, and providers’ weekly vaccination capacity. In the event of an influenza pandemic, engagement of a diverse range of provider types (from outpatient clinics to pharmacies to workplaces) is crucial to assure adequate vaccination capacity in the jurisdiction. Policy makers should consider the benefits of providing vaccination that may motivate providers to participate in pandemic vaccine dispensing.

Discussion: We have developed a model to assess the speed and efficiency of a given vaccination campaign plan. This model may be useful for decision makers to consider which providers to target with pre-pandemic outreach efforts; this information may also be useful for other public health preparedness efforts. Outreach efforts may range from agreements in which providers such as pharmacies dispense the vaccine, to provider agreements with health maintenance organizations. Local decision makers may also consider the costs associated with setting up temporary mass vaccination settings. Given the wide variety of provider categories and range of possible agreements, careful consideration of which providers to target is warranted.