They noted that local circumstances, such as publicized deaths due to 2009 H1N1, tended to increase demand. Participants suggested that examining state-level data would be helpful in addressing these issues. In addition, although county-level data are not available for all counties, where available they should also be analyzed because the factors in question may vary significantly by county within a state. Several additional research questions are described below.

In addition to the research questions suggested, participants discussed two particular overarching areas where they said that research, combined with expert review and, potentially, modeling, could be used to develop useful planning tools and enhance processes and procedures in the future. These overarching planning areas were suggested in addition to the many other suggestions for improvements to programs, processes, and tools that run throughout this workshop summary.

First, as discussed in the section on vaccine supply above, participants noted that it was extremely challenging to switch from distribution and administration plans focused on rapidly distributing large quantities of vaccine to plans focused on equitably distributing a limited quantity of vaccine. Participants also said it was challenging to switch from plans that assumed a disease with slow transmission but high mortality, H5N1, to a disease with high transmission but lower severity, H1N1. Throughout the workshops, they discussed how different strategies may be most appropriate in different situations. Participants suggested that it would be valuable to harvest data from the 2009 H1N1 response and, in conjunction with expert review and, potentially, modeling, develop a planning tool that outlines which distribution and administration strategies best ensure equitability and fairness and provide the most effective use of resources according to the characteristics of the situation. In particular, they noted that the planning tool should contain considerations for situations of shortage versus ample vaccine supply, and also recommendations regarding effective strategies according to the severity of the disease.

A second recurring workshop theme was that many processes involved in the vaccination campaign could have been simplified, systematized, and automated. This would have made the campaign more efficient and reduced error rates, they said. Participants suggested that it would be useful to examine the entire response system for ways to simplify, systematize, and automate processes and develop practices that take into



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