Universal Influenza Immunization in Adults

1. Universal Influenza Immunization in Adults Gus Birkhead MD MPH New York State Department of Health

2. Public Health Department Roles • Assessment • BRFSS • Annual flu surveillance • Outbreak investigation • Assurance • Disease control – NYS Public Health Law • Vaccine mandates • Vaccine redistribution • Health facility regulation • Medicaid reimbursement • Policy Development • Standard of Health Care • Health Promotion Programs

3. Activities of New York State Adult Immunization Coalitions • 25 local and regional coalitions supported by DOH • Develop & distribute educational materials. • Facilitate the redistribution of influenza vaccine during vaccine shortages. • Coordinate flu clinics with mass immunizers private providers. • Sponsor community events, health fairs, “Drive-through” vaccine clinics, etc.

4. Flu Shot in Last 12 Months New York State BRFSS percent

5. Flu Shot in Last 12 Months By Chronic Disease Status percent

6. Flu Shot in Last 12 Months by Age New York State BRFSS percent

7. Flu Shot in Last 12 Months By Health Insurance Status percent

9. Flu Shot in Last 12 Months By Site Where Administered percent

10. Challenges in Private Medical Offices • Capacity of private sector to physically see entire patient panel in a 2-3 month period • Reimbursement for private sector. • Medical practice cash flow issues. • Staff person-power to provide immunizations. • Limited number of nurses as immunizers. • Many adults don’t have a regular doctor.

11. Population Challenges • Lack of demand • Mixed messages: “There is a vaccine shortage but it wasn’t a bad flu season.” • Lack of reimbursement • Uninsured • Regulated insurance • Unregulated (self) insurance • Lack of capacity

12. Paradigm Shifts Needed for Universal Flu Vaccination • Public health agencies will need to have a much bigger role. • Vaccine supply will have to be made much more reliable. • Mass vaccine delivery mechanisms • Reimbursement mechanisms • Public attitudes towards flu vaccination

13. Bigger Public Health Agency Role • Only they have a population-wide view and ability to act in a population-wide fashion. Demonstrated in the 2004 vaccine shortage. • But: declining capacity, particularly at the local city/county health department level. • Getting out of direct patient care business. • BT preparedness funding is already starting to decline. • 10% drop in current year • Congressional mark ups 8-16% cut next year.

14. Reliable Vaccine Supply • 2004 Vaccine shortage resulted in the disillusionment of private sector immunizers. • Many private MDs ended up loosing money (more money than usual). • 2005 vaccine production delays do not inspire confidence.

15. Mass Vaccine Delivery Mechanisms • Need to rethink approaches • Mass vaccination at your local pharmacy? • Organized public health mass clinics? Every year?

16. Reimbursement Mechanisms • Currently medical providers have to tie up working capital in vaccines in the refrigerator, then… • Await reimbursement patient-by-patient over months (many months). • No reimbursement mechanisms for the 2-3 million (in NY) uninsured people.

17. Public Attitudes Towards Flu Vaccination • Need to create a sense of urgency (and then be able to meet it). • Risk communication challenge • Maintain sense of urgency late into the season: December, January, February… • Address public’s misconceptions: • Not a severe disease • Vaccine is harmful (“causes flu”)

18. Conclusions • Stars are not in alignment at this time. • Need paradigm shifts in a variety of areas to even make universal vaccination thinkable.