The 2020 influenza (flu) season, amid the ongoing Sars-CoV-2 (COVID-19) pandemic, prompts consideration of public health capabilities that can not only respond to concurrent impacts, but optimize growth and evaluation of vaccination capabilities. Once available, 65 percent of the population is projected to seek COVID-19 vaccinations, meaning planning for a mass vaccination campaign must begin as soon as possible. These planning efforts can launch, inform, and enhance active efforts to administer the flu vaccine.
The adoption of COVID-19 community mitigation measures has decreased interseasonal flu levels to a historic low. Adopting nonpharmaceutical interventions, such as social distancing and mask-wearing, has led to decreased influenza activity in the southern hemisphere. Currently the United States (US) has a diverse range of implemented mitigation strategies. States not currently enforcing mitigation measures may see a larger influenza response. Thus should prepare for a potential co-response event between COVID-19 and the flu.
Additionally, flu vaccinations are an essential preventative measure for decreasing influenza-related morbidity and mortality. An increase in flu activity could result in higher demand and strain on testing capacity, and the potential for higher rates of severe and fatal illness. Therefore, this season presents an important opportunity for communities to exercise future COVID-19 vaccination distribution in an actual administration environment, while allowing communities to simultaneously boost flu vaccination rates. The following are key considerations and strategies for such an effort.
- Develop Point of Dispensing (POD) plans with multiple applications. In recent years, mass dispensing for pandemic influenza has been championed through development of POD plans. As public health departments consider the dispensing and administration strategy for a COVID-19 vaccine, jurisdictions should consider using their vaccine dispensing plans for the flu season. Specifically, they should consider the use of off-site temporary vaccination clinics to dispense the flu vaccine at a larger scale, as this can serve as a pilot for future temporary vaccination clinics for COVID-19 vaccinations. Considerations adapted from these plans should include the number of individuals that are being sent to each POD (i.e., throughput), traffic patterns outside the facility, population and language considerations for the community, and staffing necessary to manage an influx of patients. As flu planning and vaccine administration continues over the coming months, real-time after-action reviews and analysis of lessons learned can alleviate similar challenges for future responses.
- Build capacity to supply reliable access to vaccines. Ensuring a sufficient supply and capability to make vaccines readily available requires proper staffing capabilities and continuous resource assessments. As health providers consider surge capabilities for a COVID-19 vaccine — and test those capabilities through the dispensation of the flu vaccine — existing programs can be strengthened by partnering with governments and nonprofit organizations. To increase accessibility, primary care physicians that have reduced operating hours due to the pandemic may be able to support administering vaccines at the POD. Additionally, Emergency Use Authorization (EUA) may allow individuals who do not have prior authorization for vaccine dispensing, such as retired medical practitioners and dental staff, to administer vaccines during a pandemic. Creative solutions which build on established policies and procedures should be identified and exercised.
- Integrate infection prevention and control during administration. During the COVID-19 pandemic, the Center for Disease Control (CDC) adjusted vaccination guidance, highlighting important considerations for dispensing plans including: physical distancing, Personal Protective Equipment (PPE), and efforts to increase sanitation practices so as to prevent further transmission. Additional considerations include: the integration of physical distancing and enhanced infection control measures, requirements that patients wear face coverings that cover the nose and mouth and use of PPE by providers or administrators including face coverings and gloves. These processes and requirements can be prepared for and established ahead of time, so they do not inhibit efficiency during the push to administer the COVID-19 vaccine.
As the COVID-19 vaccine continues to progress through clinical trials, active and critical efforts to administer flu vaccinations can be used to inform POD plans now. By exercising these capabilities, communities, health care organizations, and hospitals can gather vital lessons-learned to effectively streamline capabilities and enhance the impact of future COVID-19 vaccination efforts.
Alexandra Koch is a managing associate and public health emergency management professional with strong knowledge and experience in public health emergency preparedness and response. As a ORISE Fellow at the Centers for Disease Control and Prevention’s Division of State and Local Readiness she validated Public Health Emergency Preparedness (PHEP) Cooperative Agreement (CoAg) awardee data and assisted in the rewrite efforts for the 2019 – 2024 PHEP CoAg. She also has assisted Fulton County Board of Health for their Anthrax dispensing plans by optimizing POD locations using RealOpt.
Rachel Rosmarin is a managing associate and skilled public health professional with six years of experience providing technical assistance, research, communication, and administrative support to a range of clients. Most recently, Ms. Rosmarin provided her expertise to various clients such as the Office of Population Affairs (OPA), Centers for Medicare and Medicaid Services, and the Health Resources and Services Administration (HRSA) Emergency Medical Services for Children (EMSC). She has extensive experience coordinating research and data analysis projects and presenting recommendations and findings to various stakeholder groups for consideration in future utilization efforts.
Ashley Saulcy is a managing associate who specializes in post-disaster and post-conflict community planning and research, with experiences ranging across non-profit, government, and international development organizations. Internationally, she focused on research initiatives and governance-focused program development in West Africa and Nepal. Her current work is supporting research and stakeholder engagement to improve access to technology and forward-thinking strategies in transit and alternative housing. Her work emphasizes continuity and co-response approaches for clients seeking innovative strategies to address disruptions.