As H1N1 vaccinations taper, CDC lists changes in distribution

Mar 24, 2010 (CIDRAP News) – With the H1N1 vaccination program winding down, the Centers for Disease Control and Prevention (CDC) yesterday announced distribution system changes that will result in slower vaccine deliveries starting Apr 1.

The CDC said it is shrinking its vaccine inventory because of the expiration of doses at the distribution depots and is reducing the number of depots, to one each for vaccine and for ancillary supplies. The changes will mean "a longer shipment timeline than the current same-day-fill timeline," the notice said.

In the H1N1 immunization program, states order vaccine from one central distributor, McKesson Corp. Tables included in the CDC notice show that, following the changes, it will take 4 business days for states to receive vaccine orders and 2 business days to receive ancillary supplies. Shipments to states and territories outside the continental United States will take longer.

"These changes are being implemented based on the current status of 2009 H1N1 disease rates and vaccination activities in the US," the CDC said, adding that it is making contingency plans to increase distribution again if necessary.

A total of 162.5 million doses of H1N1 vaccine have been filled, finished, and released, CDC spokesman Tom Skinner told CIDRAP News today. That number is out of 229 million bulk doses ordered, at a cost of $1.6 billion, he said. The government had originally ordered a total of 251 million doses, but about 60% of an order from CSL Biotherapies was canceled in December in the wake of delayed deliveries.

The CDC estimates that about 86 million people have been vaccinated and about 90 million doses have been administered, according to Skinner. Children younger than 10 years are recommended to get two doses.

Under the new distribution plan, the CDC said, a vaccine depot in Memphis and an ancillary-supply depot in Columbus will serve all the states and other jurisdictions that order vaccine. Orders will still be placed in the same way as before.

Vaccine inventory at the depots has been reduced since mid February as vaccine doses have expired, the agency said. "CDC is monitoring inventory on a regular basis, but is not currently ordering vaccine/supplies to replenish the depots," the notice said. "However, in the event that product demand increases, CDC will resume replenishment orders."

Claire Hannan, executive director of the Association of Immunization Managers in Rockville, Md., said today that H1N1 vaccination efforts have diminished but are still going on.

"I know that states are planning some promotional activities for Public Health Week [Apr 5 through 11]," she said. "I don't think every state is still ordering vaccine, but I think there are still orders going."

Hannan said there's a lack of good information now on how many doses of vaccine have been administered, because vaccination providers have been somewhat slow in providing the information to the states. "The states don't have a good sense of how much inventory is out there; they don't have all the information from providers," she said.

Hannan said much of the vaccine inventory now on hand will expire within the next few months, though a Sanofi vaccine sold in multidose vials won't expire till next year. She said it's likely that some of the supply will go to waste, though she couldn't estimate how much.

"I think some states are waiting for guidance on whether to save some of that Sanofi vaccine" with the 2011 expiration date, Hannan commented. She said CDC's Advisory Committee on Immunization Practices is looking at issues such as whether states should save some of the vaccine for use this fall in children who were supposed to get two doses but received only one.

See also:

Mar 23 CDC notice of changes in vaccine supply and distribution
http://www.cdc.gov/h1n1flu/vaccination/changes_h1n1_vaccine_supply_dist.htm

Aug 10, 2009, CIDRAP News story "States to designate providers to give H1N1 vaccines"

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