Influenza pandemics were responsible for millions of deaths in the 20th Century. Most notable among the outbreaks was the pandemic of 1918, which caused an estimated 20-40 million deaths worldwide and 500,000 in the U.S. Even in years when no epidemic is declared, the U.S. suffers approximately 36,000 influenza deaths annually. With mounting concern about the emergence of more virulent strains, and with the recently isolated Avian Flu establishing a presence in Southeast Asia, world public health organizations are redoubling their efforts to prevent future epidemics from occurring.

This report is the culmination of research efforts authorized by House Resolution 598 (Pr. No. 3436) of 2004, which directed the Joint State Government Commission to make recommendations on how Pennsylvania could best prepare for an influenza epidemic and ensure an adequate vaccine supply.

It must be noted that flu vaccines are produced and distributed by the private pharmaceutical market. While governmental agencies at the state and local level routinely purchase doses from the Centers for Disease Control and Prevention (CDC), the CDC purchases its supply through private contractors.

The market for vaccines fluctuates as any market does: periods following supply shortages are likely to be oversupplied, while periods of excess supply are likely to see reduced numbers of vaccines brought to market. Shortages are punctuated by dramatic price increases while abundance leads to lowered prices.

The vast majority of vaccines are administered through the private sector, in such places as doctors’ offices, hospitals, and, more recently, retail stores. Relatively few immunizations are administered through public sector outreach programs. Thus, the most advantageous roles for governments to assume are those of planning for and coordinating influenza control, and in educating both providers and the public.

SUMMARY OF RECOMMENDATIONS
This report makes the following recommendations:

• • Pennsylvania Department of Health (PADOH) should continue to take full advantage of its partnership with the CDC to prepare for outbreaks, purchase vaccines, and successfully stanch an epidemic should one establish itself.
  • PADOH should encourage employers and schools to implement influenza education programs that highlight the dangers of flu and encourage immunizations.
  • Healthcare workers should be strongly encouraged to get annual vaccinations. In order to accomplish this goal, it is recommended that they be educated about the dangers posed by not being immunized. Further, it is recommended that their employers reduce or remove barriers, such as cost or inconvenience that may discourage immunization.
  • PADOH should continue its partnerships with local and private entities in providing immunizations at shelters, churches, community centers and low-income housing sites. Further, it should continue to investigate including daycare centers as potential vaccination venues.
  • PADOH should continue its innovative use of the Pennsylvania Health Alert Network (PA-HAN), the Vaccine Management Information System (VACMAN), and the State Immunization Information System (SIIS) to monitor and coordinate the redistribution of vaccines when necessary.