Review and special article
Strengthening the Nation’s Influenza Vaccination System: A National Vaccine Advisory Committee Assessment

https://doi.org/10.1016/j.amepre.2005.05.011Get rights and content

Introduction

Each year more Americans are vaccinated for influenza than for any other disease. Although vaccine shortages and delays have garnered much attention during the past several years, it is important to highlight the success of the program: Millions of people are vaccinated in a short time period each year; good collaboration exists between the public and private sectors, which have documented an ability to respond appropriately to vaccine supply problems and other events; and healthcare providers and the public have acted responsibly in targeting vaccines to those who need it most at times of shortage. Nevertheless, one cannot underestimate the importance and impacts of vaccine supply shortage, particularly that occurring for the 2004–2005 season. A sufficient and predictable vaccine supply is critical for a successful prevention effort.

Several interventions have been implemented to reduce the risk of disruptions to the future supply of vaccine, to strengthen influenza vaccine security, and to foster preparedness for an influenza pandemic. In 2004, the Acting Assistant Secretary for Health, Department of Health and Human Services (DHHS) requested that the National Vaccine Advisory Committee (NVAC) evaluate strategies and capabilities to improve influenza prevention efforts in the United States. An NVAC Influenza Vaccine Working Group evaluated both published and unpublished data and held discussions with stakeholders—including industry, public health officials, providers, purchasers, and consumers—to develop a set of recommendations. Based on the findings, the Working Group developed several recommendations that can be used to improve influenza prevention efforts in the United States. This report summarizes those recommendations.

Section snippets

Background

The Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) recommend annual influenza vaccinations for people at increased risk of severe influenza infection, their close contacts, and all healthcare workers.1 Influenza vaccination uptake increased dramatically through the 1990s. However, since the late 1990s, of the 185 million people for whom the vaccination is recommended, only about 80 million are vaccinated in a typical influenza season.

Process

At the request of Cristina Beato, MD, the Acting Assistant Secretary for Health, NVAC established a working group to evaluate strategies to reduce the impact of influenza disease in the United States and to make recommendations on how to substantially improve the prevention of influenza and reduce disease burden. The working group was encouraged to ask challenging questions and consider new strategies, paradigms, infrastructures, and technologies as well as incremental changes that could be

Vaccine Financing and Demand

1. Improve vaccination coverage among recommended groups by facilitating the delivery of influenza vaccines in a range of settings, especially in “medical homes,” other medical sites, workplaces, and community sites where people have not previously had access to vaccination.

Rationale: Several barriers exist to achieving high rates of influenza vaccine coverage among recommended groups through vaccination at primary care provider offices.22, 23 While children commonly make routine age-based

Concluding Remarks

A wide range of influenza disease- and prevention-related research is being supported and conducted by multiple agencies in the public and private sectors. An influenza research program review that describes ongoing activities, defines key objectives, and also identifies gaps in the research portfolio is an important first step in strengthening the program and providing the techniques and tools that will improve the ability to prevent the most common and most deadly of all vaccine-preventable

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References (42)

  • Assessment of the effectiveness of the 2003–04 influenza vaccine among children and adults—Colorado, 2003

    MMWR Morb Mortal Wkly Rep

    (2004)
  • Preliminary assessment of the effectiveness of the 2003–04 inactivated influenza vaccine—Colorado, December 2003

    MMWR Morb Mortal Wkly Rep

    (2004)
  • J.A. Wilde et al.

    Effectiveness of influenza vaccine in health care professionalsa randomized trial

    JAMA

    (1999)
  • D.M. Fleming et al.

    Study of the effectiveness of influenza vaccination in the elderly in the epidemic of 1989–90 using a general practice database

    Epidemiol Infect

    (1995)
  • D.S. Campbell et al.

    Cost-effectiveness of the influenza vaccine in a healthy, working-age population

    J Occup Environ Med

    (1997)
  • C.B. Bridges et al.

    Effectiveness and cost-benefit of influenza vaccination of healthy working adultsa randomized controlled trial

    JAMA

    (2000)
  • V. Demicheli et al.

    Vaccines for preventing influenza in healthy adults

    Cochrane Database Syst Rev

    (2004)
  • J.W. Smith et al.

    Vaccination against influenzaa five-year study in the Post Office

    J Hyg (Lond)

    (1979)
  • E.A. Blumberg et al.

    The immunogenicity of influenza virus vaccine in solid organ transplant recipients

    Clin Infect Dis

    (1996)
  • L. Dorrell et al.

    Clinical and serological responses to an inactivated influenza vaccine in adults with HIV infection, diabetes, obstructive airways disease, elderly adults and healthy volunteers

    Int J STD AIDS

    (1997)
  • J.E. McElhaney et al.

    Age-related decline in interleukin 2 production in response to influenza vaccine

    J Am Geriatr Soc

    (1990)
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    Address reprint requests to: Bruce G. Gellin, MD, MPH, Director, National Vaccine Program Office, Department of Health and Human Services, 200 Independence Avenue, SW, Room 725H, Washington DC 20201-0004

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