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195 million doses of H1N1 flu vaccine to be distributed


ATLANTA The pharmaceutical supply chain is gearing up to distribute as many as 195 million doses of H1N1 flu vaccine across 90,000 points of delivery, as decided by each state, through four yet-to-be-disclosed McKesson distribution centers.

“How many of those are providers versus … situations such as a retail chain that will then redistribute it among their outlets, I don't have a good handle for that yet,” said Jay Butler, chief of CDC’s 2009 H1N1 vaccine task force commented during a press briefing Sept. 18. “It's important to recognize that the 90,000 [points of delivery] is not always a provider's office but it may be a point where the vaccine will then be distributed even further within a jurisdiction or within a company.”

The vaccine distribution will begin as a trickle, as early as next week, with at least 3.4 million doses of MedImmune’s FluMist (a live attenuated H1N1 virus delivered through the nasal cavity) ready to roll, as well as possible injection vaccines from one of three approved manufacturers — CSL, Novartis Vaccines and Diagnostics, and Sanofi Pasteur. A fourth manufacturer, GlaxoSmithKline, reported last week that it’s H1N1 vaccine candidate can provide a strong immune response with only one dose in a clinical trial involving 130 healthy adults.

By mid-October, CDC anticipates some 20 million H1N1 vaccines will flow through that distribution center every week, reaching a projected target of 195 million doses distributed by year’s end.

“The centralized distribution system is one that's very similar to what's used currently for the federal Vaccines for Children program,” Butler said. “This distributes federally purchased vaccine out to about 40,000 sites nationally [through McKesson] already.  So this system has been enhanced, and there's been outreach at the state level to be able to enroll additional providers to be able to administer the vaccine.”

The ordering process, beginning from the provider, will be a request for vaccine that will go to the state health department. The state health department immunization coordinator each day will know the allocation of vaccine available to that state. And at the state and local level the requests will be basically triaged to be able to direct where the vaccine goes, and then those orders will be transmitted daily to CDC, where they'll be collated, Butler explained. “First thing, the day's orders will be transmitted to the distributor, roughly 5 a.m. the next morning, and then those orders will start being filled and they'll be filled within three business days. When the order is filled, it'll be shipped by overnight express from the distributor to the provider, and those shipments will not occur on Friday or Saturday, of course, because we don't want vaccines showing up at locked doors or not being controlled or available.”

The H1N1 vaccine has been purchased by the government, and as such no provider will be allowed to charge for the actual vaccine. However, providers in the private setting may charge an administration fee.

The Advisory Committee on Immunization Practices provided recommendations on who should receive the vaccine first based on the epidemiology of disease — younger people, adults with underlying illnesses and such people who are at risk of transmitting the illness as health care workers or people who live with or care for infants younger than 6 months of age, an age at which vaccination is not possible, Butler said.

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