distribution of antiviral medications will require not only considerable public health agency involvement, but also leadership. Several aspects of the vaccine shortage are noteworthy, and some are especially relevant to antiviral distribution and dispensing.

  • Vaccine delivery systems vary from state to state.

  • Differences among health departments in prioritization and implementation created public confusion.

  • There was a need to prioritize initially, but the range of priority groups broadened with time as successful coverage of high-need groups allowed some flexibility in the use of remaining vaccine. However, the change in priority groups was hard to implement and communicate, and in the end, some vaccine went unused.

  • Some states invoked an emergency order to restrict vaccine distribution to specified groups. Some states held mass vaccination clinics for target groups; others directed the existing provider infrastructure to administer vaccine only to priority groups. One state held a lottery.

  • The Health Alert Network was used in communication between the Centers for Disease Control and Prevention (CDC) and the states. States also used existing communication plans.

  • The Health Alert Network was a helpful mechanism for disseminating secure information, and it would likely play a similar role in a pandemic, assuming no drastic changes in technologic capacity and availability of electrical power (Hannan, 2008).

  • State public health agencies played an unusual role as facilitators of vaccine reallocation. Given some concerns about the Strategic National Stockpile scheme for allocating to states (e.g., not accounting for seasonal displacement) and some differences in states’ ability to purchase and stockpile antivirals, it is conceivable that a limited process of reallocation may become necessary in a pandemic.

  • A centralized CDC-based ordering system developed a few weeks after the emergency began, and there were some difficulties that having a system already in place would have prevented. This reflects the challenge of having needed information systems in place at the time of a pandemic.

  • Daily CDC partner calls were a helpful component of the response to the public health emergency. This may speak to the need for such close collaboration in a pandemic, although it cannot be overstated that a pandemic could place vastly greater burdens on public health partners’ time and ability to confer.

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