Workgroup Three (The Orange Group)

1. Workgroup Three (The Orange Group) • Vaccine Supply • Vaccine Distribution • Vaccine Financing • Key issues • Barriers • Needs • Solutions

2. Vaccine Supply & Distribution: Barriers • Unpredictable production • Multiple products and formulations • Importance of timing of vaccine availability • Inherent challenge in balancing supply and demand/utilization

3. Vaccine Supply & Distribution: Barriers • Information • Not very coordinated right now • Who gets what and when? • Unclear how influenza distribution in the public sector will work this year – first year using the centralized system • How does influenza vaccine travel through the distribution network? • Byzantine path from manufacturer to implementation points

4. Vaccine Supply & Distribution: Needs • Improved uptake and demand • Minimize waste of vaccine • Change in providers’ mindsets • Why do all doses have to arrive in September and October? • Opposition to non-traditional sites • Inconsistent with push to extend the vaccination season and knock down access barriers • Change in public’s mindsets • Need to be vaccinated annually and vaccinated throughout the season, irrespective of risk profile

5. Vaccine Supply & Distribution: Solutions • Communications • Multiple levels • Better communications between and amongst stakeholders about vaccine yield and production • Need information for contingency plans • Improves consistency and combats rumors and misperceptions • Make sure that all the information trickles down to the levels of implementation • Better communications to providers and the public • Helps combat complacency • What are the message maps that work that drive demand? Identifying those will be helpful

6. Vaccine Supply & Distribution: Solutions • Improve Flu Finder • Local access to SNS data • Granularity of the data • Improved operational support to implement the expanded recommendation • Partnerships • Identifying and disseminating best practice models • Model private provider practices • Models of what works in communities

7. Vaccine Supply & Distribution: Lingering Questions/Issues • Does public health want to take on the role of community coordinator? • Who will take charge of identifying, documenting, evaluating, warehousing, and disseminating best practices?

8. Vaccine Financing: Barriers • Accountability for vaccine is important challenge • Lots of suggestions about points of access but more involved than just getting vaccine doses to those places • Full access to vaccines is expensive • Gaps exist for underinsured children • These situations put health departments in “ethically tense” situations

9. Vaccine Financing: Needs • Financing of expanded recommendations • Adequate, timely federal and state discretionary funds • Managed care / private insurance funds • Adequate administration fee • State appropriated funds • Local funding support • Federal Section 317 program funds

10. Vaccine Financing: Solutions • Work with state Medicaid agencies to increase the administration fee toward the allowable amount • Continue the dialogue on vaccine financing • NVAC • AAP • Flu Summit

11. Vaccine Financing: Solutions • Make influenza vaccination a “standard of care” issue • Mobilization of state and local resources • Focus on resources vs deficits • The discussion should not be about how much money is being spent on implementing influenza recommendations, it should be on how it is being spent

12. Final Thoughts • Many have repeatedly stated in different ways that “implementation will be local” • If we really want to meet the challenges of implementing the expanded recommendations, then let’s recognize the value of a robust public health infrastructure and support it accordingly • The rubber meets the road at the local level, and there is not a lot of tread on the tires

13. Final Thoughts • There’s a whole new world of stakeholders out there • Renewed vigor with Federal/State health officials • Renewed vigor with non-traditional partners • Renewed vigor with medical care providers/institutions • Renewed vigor with social service agencies – reaching the hard-to-reach • (Re)new relationship with business community • Renewed vigor with schools • (Re)new vigor with faith communities • Renewed emphasis on communications

14. Overarching • Barriers • 20th century systems, thinking, and practices attempting to implement 21st century recommendations • Needs • Thorough review of current systems and practices – desperate need of updating • Solutions • Transformation of public health and health care systems (no tinkering around)