CDC Heads Off Vaccine ShortfallCDC Heads Off Vaccine Shortfall

When contamination of flu vaccine from a major European supplier, Chiron Corp., last fall resulted in a shortfall of 48 million doses for the United States, the Centers for Disease Control and Prevention needed to react quickly.

An important piece of the CDC's response was figuring out how to redeploy shipments of vaccine from a second supplier, Sanofi Pasteur MSD (formerly Aventis Pasteur), to U.S. states and cities that had the worst shortages--places where shipments had been expected to come predominately, and in some cases exclusively, from Chiron. To tackle the crisis, the CDC accelerated and completed in one week the development of software that had been part of a broader, multiyear IT project called the countermeasure response system.

Specifically, the centers ramped up development of flu vaccine-finder applications, which helped the CDC, U.S. public-health departments, and vaccine maker Sanofi Pasteur and its distributors locate inventories of flu vaccine and discover where there were shortages. The applications also helped reapportion shipments to where they were most needed.

"Like many processes in health care, this work had been more manual," says Dr. John Loonsk, the CDC's associate director for informatics. "This is a significant step to real-time capacity management for public-health crises."

Typically, vaccines are produced and delivered directly to the customers who order them. But because Chiron couldn't fulfill orders for millions of doses of vaccine, the CDC needed to proactively apportion vaccine in the supply chain to better address the needs, Loonsk says. The development of flu vaccine takes months, so a manufacturer has a limited ability to ramp up huge, unexpected volumes of vaccine quickly in time for the influenza season.

Sanofi Pasteur supplied the CDC with inventory and supply-chain data about its flu vaccine being manufactured and planned for shipment. Through a CDC Web site, state and local public-health officials were able to access information about supplies of the vaccine and place their orders so that shipments could be allocated by need, Loonsk says.

Steve Nickell, immunization program director at the New Mexico Department of Health, says the site helped him by locating which counties in the state had supplies of vaccine and which did not. Using a digital certificate issued to him by the CDC, Nickell was able to access the secure vaccine-finder site to see, for instance, weekly updated listings of what health-care providers in the state had vaccine shipped to them and the number of units. Armed with this information, New Mexico public-health officials were able to help arrange redeployment of vaccine to providers in the state that didn't have adequate supplies based on population statistics and ratios.

While that information was useful, Nickell says, less helpful was the ability to place vaccine orders on the site. That's because distributors didn't act quickly enough when orders were placed, causing some health-care providers that waited several weeks for shipments to cancel their orders and acquire vaccine from other sources. Nickell attributes those problems to individual distributors, rather than the CDC site.

The new flu-vaccine applications are part of the CDC's ongoing work to automate and optimize public-health processes, Loonsk says. The CDC is broadening these systems to help manage treatment supplies and drugs in the face of other public-health crises, including naturally occurring diseases and bioterrorism, he says.

That's in the nation's best interest, Nickell says. "In the future, when a pandemic happens--not if, but when--a tool like this with information about where vaccines are and where they're going will be valuable."