The Florida Department of Health developed a Concept of Operations to expand its vaccination campaign beyond the ACIP priority groups. The document allowed county health department (CDH) Directors/Administrators to decide when was the most appropriate time for their jurisdiction to move to the next phase(s) of the H1N1 mass vaccination program and provided guidelines for each phase.
Florida's H1N1 influenza mass vaccination program aimed to immunize all Floridians and visitors who choose to be vaccinated. Florida began vaccinating the CDC recommended priority groups and then expanded beyond those groups as vaccine becomes available.
The Florida Department of Health organized the H1N1 influenza vaccination campaign into four phases consistent with the ACIP recommendations: priorities were based on those most at risk for a negative health outcome from the disease.
- Phase 1: Pregnant women; persons who live with and provide care for infants aged less than six months; healthcare and emergency medical services personnel who have direct contact with patients or infectious material; children aged six months to four years; children and adolescents aged 5 to 18 years who have medical conditions that put them at higher risk for influenza-related complications
- Phase 2: Healthcare and emergency medical services personnel; persons aged 5-24 years; persons aged 25-64 years who have medical conditions that put them at higher risk for influenza-related complications
- Phase 3: Persons aged 25-64; persons 65 and older with chronic health conditions
- Phase 4: Persons aged 65 and older
In the Concept of Operations, demand for H1N1 vaccine was predicted based on public concern for protection against H1N1 and public acceptance of the vaccination as a viable choice for protection. The Florida Health Department estimated the number of people who may seek H1N1 vaccine for three levels of acceptance: 33%, 50%, and 75% acceptance rates.
Vaccine availability and utilization were also predicted, using national planning estimates, and doses administered reporting, which is required for all providers in Florida. Florida also conducted a qualitative survey of county health departments to determine their estimates of target populations reached. Based on the final survey data, 60 counties, representing 98% of the total Florida population, indicated when they would be ready to expand their vaccination campaign beyond the ACIP priority groups.
Counties were asked to consider disease uncertainty, sufficient quantity of vaccine, and private provider vaccine utilization as they planned to open vaccination beyond the priority groups. In implementing the various phases of vaccination, counties were also asked to consider the following: that reasonable efforts had been made to reach priority groups, the impact of seasonal and non-resident visitors; how expansion of vaccination might affect neighboring counties and border states; how to deal with Phase 3 sub-groups, especially if demand were to exceed supply; and messaging the county vaccination plan.
All areas expanded vaccination to all populations by January, 2010. The plan helped to provide a systematic approach that all the local health departments could follow as they transitioned to open vaccination without having to figure out all aspects independently. The state department is currently gathering data on the total number of vaccinations that have been administered across groups, as well as best practices in the implementation of the vaccination campaign in different counties.