H1N1

Current Pandemic Influenza Readiness within the US Center for Disease Control
Name
Institution

Abstract
This research explores the status of the pandemic preparedness against influenza virus by the CDC the PHEP awardees. The 2009 H1N1 influenza pandemic shows that the dynamics of the virus remain unpredictable. The PIRA survey provides data for 30 such awardees across the United States to determine their capability to completely vaccinate 80 percent of the population within their jurisdiction. The answers from these surveys would be analyzed descriptively. Most of the PHEH awardees cannot achieve the vaccination quota required over the proposed period. Staffing issues and a disparate CDC program that runs parallel to existing structures of distribution are likely to hinder the intended vaccination initiative in a probable pandemic. An integrated and coordinated approach to dealing with the influenza virus dynamics is necessary. The prevention of pandemic-scale infection with an H1N1 or other Influenza A viruses has to occur in a multi-faceted fashion that works at both primary, secondary and tertiary levels.
Keywords: PHEP awardees, pandemic, influenza, influenza A virus

Introduction
Influenza pandemics have dotted history with their unexpected emergences that result in hefty health and economic burdens. The 1918 influenza A virus pandemic saw to death of nearly 50 million people, while the 2009 H1N1 pandemic virus was met with ardent mitigating strategies that led to only about 14,000 deaths (Medina, 2018, p.

61; Crosier, Mcvey & French, 2015, p. 61). Despite the mastering of the molecular basis relating to residues of the hemagglutinin glycoprotein that makes the zoonotic virus ligands for receptors on the epithelial cells within the mammalian upper respiratory tract expressing α- 2, 6-linked sialic acids, its re-emergence might still cause an epidemiological scare. This information enables the characterization of the virus for all levels of prevention and care. However, this latter pandemic began in Mexico; possibly, due to lax animal surveillance that allowed swine to be intermediate hosts for the virus enough for its reassortment to be viable in humans (Medina, 2018, p. 62). Development of a vaccine and its extensive distribution in case of a pandemic is sure to reduce infection and mortality rates from a recurrent H1N1 or novel influenza virus pandemic (Fitzgerald et al., 2017). This research intends to analyze and recommend the preparedness of the CDC in the US if an H1N1 virus pandemic recurs.
In case of an H1N1 or a novel influenza virus, the Centers for Disease Control and Prevention (CDC) provide for the distribution of the commensurate vaccine for a 2-dose regimen administered within a span of 21 days for a maximal immunologic response and optimal guard from infection. State-run and local public health entities are charged with the responsibility of distributing the vaccine to the populace for administration.
The CDC’s Public Health Emergency Preparedness awardees (Program) sees to the awarding of 50 states, 3 self-sponsored jurisdictions, 8 unincorporated states and Washington (CDC 2015). All these entities took park in a Pandemic Influenza Readiness Assessment (PIRA) survey conducted online. The collected data from the PIRA surveys prove sufficient to analyze the nation-wide preparedness for vaccination in case of a pandemic incident.
Methodology
The study sample would include the 30 PHEP awardees that the CDC charges with a response through vaccination in an influenza epidemic over a wide area in the United States. The Pandemic Influenza Readiness Assessment survey (PIRA survey) would reveal their readiness to administer the 2-dose vaccine over 21 days among 80 percent of their population over a period of 16 weeks. The survey simulates a serious influenza pandemic in the future affecting all ages and peaking at 20 weeks after observation within the United States. Moreover, the national vaccination campaign would be bound to begin 60 days after its announcement availing enough vaccine to vaccinate about 10 percent of the population weekly. Also, the demand for the vaccine would be soaring. Selected PHEP awardees would then fill in the survey within this context together with their previous preparedness and alterations in the immunization.
The PIRA survey responses would be descriptively analyzed on Microsoft Excel, and open-ended answers then classified and counted. Proportions and frequencies of answers will be calculated, and multiple answers within the same category would be counted as one. The 30 highest populated states were selected to assess the vaccination capacity of the structures in place to guard against a severe pandemic virus.
Results
Table 1 reports most of the data collected from the analysis of the PIRA survey responses of the 30 jurisdictions. The data reports the percentage of PHEP awardees that are capable of achieving their quota of vaccination in a future severe influenza epidemic with reduced capacity in 14 (46%) of the jurisdictions relative to past years with high turnover rates of the workforce between 2012 and 2015. The trends of such preparedness and the reason for their shifting would be derived from the results too. 10 (36%) of awardees note a specific reduction in the immunization staff. Overall, 18 (63%) of the 30 awardees confirmed their capability to distribute and administer the vaccine to 80% of the people within their jurisdiction in the estimated 16 weeks. 25 of the awardees, including 15 of those capable of achieving the vaccination quota within 16 weeks, reported difficulties in achieving these objectives. The most potent challenges were staffing in up to 17 (58%)awardees together with the enlisting immunization personnel in 13 jurisdictions.
4 (16%) awardees claimed to be capable of vaccinating their entire populations with the existing public health infrastructure that has created room for points of dispensing (PODs). Another 4 awardees report their public health system is anticipated to accommodate the vaccination of 75% of their population, while 12 (40%) awardees’ public health system was expected to cover 50% of their population for vaccination. 7 (26%) awardees reported an estimated capacity of only 25% from the public health system in place. The awardees reported their willingness for engaging other viable vaccine provides such as private grownup and pediatric care providers and pharmacies. 18 (63%) allocated 20% of their vaccine to PODs where the staffing challenges present.
Any correlations between the PHEP awardees that fail or succeed to meet their vaccination quota in accordance with the simulation within the PIRA surveys would also be a crucial result. Only 12 (42%) of the awardees had staff for these PODs on standby, 7 (26%) of them had staff for the PODs without the funding to sustain them while 5 (18.4%) were still grappling with acquiring staff for PODs while 3 (13.1%) of awardees had not begun initiatives to acquire staff for PODs.
There were not any identifiable correlations among the awardees who reported inability vaccinate 80% of their populations with the double dose of pandemic H1N1 or novel influenza virus within the mandated 16 weeks. Similarly, correlations were not evident among awardees who dumped over 75% of the vaccination of their population to the public health system.
Discussion and Recommendation
Fitzgerald et al. (2017) report that the 2009 H1N1 pandemic was vaccinated against mostly within pharmacies, occupational settings, and conventional medical provider sites. With PHEP awardees, widespread and effective dissemination of the vaccine in a probable similar pandemic in the future might require additional avenues of distribution alongside collaborative partnerships with other stakeholders. However, most awardees have engaged in proactive planning through PODs that present numerous challenges. The most probable challenge of such an effort might be the staffing insufficiencies of PHEP awardees. Fitzgerald et al. (2016) blame such limitations on the underwhelming use of preexisting structures such as medical premises or pharmacies to the advantage of PHEP awardees. Srivastav et al. (2015) further explicate this wasted vaccinating potential as they note that occupational health clinics and pharmacies have the advantage of familiarity, workable operating hours and prevalence for the working population seeking vaccination in such a case. A conflated and organized front in response to a severe influenza epidemic would create an efficient framework for aptly attaining optimal coverage of pandemic vaccination.
To reduce morbidity and mortality in case of a severe influenza pandemic, the vaccination campaign has to be ready for implementation forthwith. Checking for personnel and other resources has to remain a priority as they are readily exhausted in an overly extended vaccination initiative (Fitzgerald, 2016). Moreover, PODs rarely work in conjunction with the existing healthcare structures to streamline this process. In part, this lack of synchronization among these primary stakeholders in a pandemic situation is due to their vastly differing focuses. Mostly, healthcare providers and clinical care areas will be engrossed with dealing with sick clients to reorient themselves with vaccination activities. Proactive creation of a framework for collaboration is necessary to ensure the rapid vaccination of patients within a severe influenza pandemic (Fitzegald et al., 2017).
The American Pharmacists Association (2016) has appreciated leveraging of pharmacists in a rush to immunize massive populations in an influenza pandemic. Pharmacists present a trained workforce that is increasingly receiving licensure to vaccinate people across the US and its other territories. Srivastav et al. (2015) estimate that a quarter of all US adults receive their seasonal vaccines for influenza from a pharmacy or a retail context. The US boasts of up to 67,000 community pharmacies while 297,000 pharmacies dot the region (Fitzgerald et al., 2016). Moreover, 86 percent of the US population lives proximal (about 5 miles) to a pharmacy (Rothholz, 2016; SK&A, 2016). Therefore, the task at hand is the orientation of pharmacies on the dynamics of pandemic influenza vaccination that differs from seasonal vaccinations that they are accustomed to in practice.
A severe influenza pandemic leads to a nation-wide procurement of the vaccine batches available for the pandemic by the Federal government for proportional distribution across the states. Healthcare providers interested in administering the vaccine would then ordinate with the jurisdictional health system to obtain the vaccine rather than from the typical vendors that provide the vaccine for seasonal vaccinations (Fitzgerald et al., 2016). Pharmacists are part of the healthcare providers licensed to partake in the pandemic vaccination campaign only with the provision of their shipping addresses, local demographics and vaccine stashing and handling capabilities (Fitzgerald et al., 2016).
These differences in seasonal and pandemic vaccination campaigns endear the integration of pharmacies, among other licensed healthcare providers, to comprehend the logistics of such an endeavor beforehand. Correspondence between the PHEP awardees with such third-party vaccination staff is crucial to ensure the viability and updating of their practicing premises for such massive vaccination efforts. State-level supervision of these efforts by the public health vaccination bodies is crucial as they are conveniently in touch with third parties to maintain supervision of its allotment, distribution, and administration within their locality.
Vaccination is one among numerous other proactive measures to curb the exacerbation of a possible future pandemic relating to these viruses. Even on the detection front, Medina (2018) called for an integrated surveillance program for respective animal hosts within the significant geographical locations globally. Climate change is a factor to consider as it has altered avian migration patterns and a population of reservoirs (Medina, 2018, p. 62). Such occurrences ensure the incessant evolution of influenza A viruses that heighten the probability of another pandemic. Therefore, mitigation processes should consider all these factors to ensure prevention and control of these highly fatal viral infections at all levels.
The findings of these research indicate that the pandemic influenza vaccination preparedness has numerous limitations. Funding problems, understaffing and weak collaborative vaccination efforts make it difficult to achieve the demanded quota of vaccination in case of a pandemic. Vaccine formulation is the least of worries in this century as it was in 1918 (Medina, 2018). The existing challenge lies in distribution and administration within jurisdictional boundaries with differing capabilities to do so (Fitzgerald et al., 2016; Fitzgerald et al., 2017). Therefore, the inclusion of pre-existing healthcare structures used in seasonal influenza vaccination in pandemic influenza vaccination might just be niche yet to be exploited fully so that the world can rest easy that an unexpected pandemic can be countered with effective mitigating forces.
Conclusion
A pandemic influenza readiness assessment is crucial in determining the status of public health within the US should an H1N1 or any other influenza A virus pandemic occurs. The PIRA surveys provide a readily available database for analyzing the preparedness of the CDC-inspired PHEP awardees in vaccinating the population in case of severe influenza virus pandemic. The singling out of a single entity to carry out this duty disregards the far superior integrated and collaborative approach in handling such a scenario. Awardees have to be encouraged to optimize resources at their disposal to optimize their vaccination efforts. Therefore, the structure in place to vaccinate the population in case of a severe influenza pandemic is insufficient.

References
American Pharmacists Association (APhA) (2016). Pharmacy-based immunization delivery. Retrieved from http://www.pharmacist.com/pharmacy-based-immunization-delivery.
Centers for Disease Control and Prevention (2015). Funding and guidance for state and local health departments. Retrieved from http://www.cdc.gov/phpr/coopagreement. htm.
Centers for Disease Control and Prevention (2016). Pandemic basics: questions and answers. Pandemic influenza. Retrieved from https://www.cdc.gov/flu/pandemicresources/basics/faq.html#protect
Crosier, A., Mcvey, D., & French, J. (2015). ‘by failing to prepare you are preparing to fail’: lessons from the 2009 H1n1’swine flu’pandemic. European journal of public health, 25(1), 135-139.
Fitzgerald, T. J., Kang, Y., Bridges, C. B., Talbert, T., Vagi, S. J., Lamont, B., & Graitcer, S. B. (2016). Integrating pharmacies into public health program planning for pandemic influenza vaccine response. Vaccine, 34(46), 5643-5648.
Fitzgerald, T. J., Moulia, D. L., Graitcer, S. B., Vagi, S. J., & Dopson, S. A. (2017). 2015 Pandemic Influenza Readiness Assessment Among US Public Health Emergency Preparedness Awardees. American journal of public health, 107(S2), S177-S179.
Medina, R. A. (2018). 1918 influenza virus: 100 years on, are we prepared against the next influenza pandemic?. Nature reviews. Microbiology, 16(2), 61-62.
Rothholz, M. C. (2016, May 10). Pearls of wisdom: instilling the importance of vaccinations – from student to practitioner. National Adult and Influenza Immunization Summit, Atlanta, GA.
SK&A (2016, March). National pharmacy market summary: market insights report.
Srivastav, A., Williams, W. W., Santiabanez, T. A., Khan, K. E., Zhau, Y., Lu, P., … & Liu, L. (2015). National early season flu vaccination coverage, United States, November 15.

Appendix
Table 1 PHEP Awardee (n= 30) Pandemic Influenza Vaccination Preparedness in the United States, 2015