Oklahoma expanded its vaccination program to include all Oklahomans the week of November 15, 2009, after a great deal of internal discussion. Early in the response, the state department of health formed a decision-making committee of executive staff who met weekly to closely monitor the outbreak situation and track local vaccine supply and demand. Overall, the decision to expand was a positive one for the state.
Five factors led to the decision:
(1) the number of doses administered to ACIP target group members was on the decline,
(2) Influenza-like-illness (ILI) had peaked in mid-September/October,
(3) surveillance revealed H1N1 influenza-related deaths in Oklahomans over 65 years,
(4) demand for vaccine among all groups was starting to wane, and
(5) healthcare providers were reaching storage capacity in their refrigerators.
Early in the outbreak, the health department began its vaccination program by predominantly pursuing school sites and expanded its target group week by week. By early November, Oklahoma was targeting all ACIP recommended priority groups. The state organized a Saturday vaccine blitz at several clinics across the state geared towards all five ACIP priority groups. Despite being very well publicized, these clinics did not generate high attendance.
At the same time, state health officials noted a decrease in ILI among school-aged children and a slight increase of ILI among adult populations. In addition, healthcare providers were getting pressure from senior groups (65+) who heard that providers were sitting on vaccine in their offices. Based on these findings, the state department of health decided to expand the program to the entire population in mid-November. Oklahoma publicized the expansion through local television, radio, and newspaper outlets. The goal was to increase coverage rates by vaccinating as many individuals as possible and to utilize the vaccine already in storage.
The first week of the expansion (November 15, 2009) saw a 70 percent increase in demand from the previous week. There were 40,000 additional doses of vaccine administered over the previous week's rate, and uptake was very high among the elderly. Demand trends normalized the following week as numbers returned to pre-expansion levels (approximately 36,000 doses per week).
Oklahoma suggests other jurisdictions expect a surge in demand during the first week after expanding an influenza vaccination program. Health departments and providers should ensure they have an adequate supply of vaccine to sustain the initial surge. Communication is also very critical to the success of the initiative and jurisdictions need to maintain good relationships with their local media.
