How H1N1 Vaccine is Allocated in New York State

The policy guiding the distribution of vaccine in New York State is to disperse all available vaccine as widely as possible and as quickly and efficiently as possible to reach individuals in priority groups through a variety of venues, including county health department clinics, hospitals, community health centers, private physician practices, employee health services, colleges and universities, and pharmacies.

How the Vaccine Distribution System Works

  • The federal Centers for Disease Control and Prevention (CDC) allocate available H1N1 flu vaccine to states based on each state's percentage of the national population (a per capita allocation).
  • For New York State, this results in an allocation of 6.3% of the national vaccine supply – 3.6% to the 57 counties outside of New York City and 2.7% to New York City.
  • The New York State Department of Health (DOH), which allocates vaccine to providers in the 57 counties (New York City Department of Health allocates within New York City,) likewise then calculates a per capita allocation of available vaccine based on each county's percentage of the combined counties' population.
  • All health care providers in each county (county health departments, hospitals, community health centers, private practices, pharmacies, employee health services, etc) have been urged to register with DOH to receive vaccine. This registration is a federal CDC requirement that includes an attestation by the provider that the vaccine will be administered only to individuals in established priority groups determined by the CDC to be at increased risk for serious illness from the H1N1 flu or who may be a potential source of infection for vulnerable patients. To date, approximately 5,000 providers have registered in the 57 counties.
  • The priority groups to receive vaccine are:
    • Pregnant women;
    • Persons who live with or provide care for infants under six months of age;
    • Children and young people ages six months through 24 years;
    • Persons aged 25 through 64 years who have medical conditions that put them at higher risk for serious illness and influenza-related complications; and,
    • Health care workers and emergency medical services personnel.

Where Has the Vaccine Been Shipped?

  • The first two allocations authorized by the CDC for New York State (outside New York City) were 59,500 doses on October 1 and 48,600 doses on October 2. These doses were all the nasal spray form of vaccine appropriate for healthy individuals ages 2 to 49.
  • To get these first two batches of vaccine out as quickly as possible to priority groups, DOH directed CDC to ship those doses directly to hospitals, community health centers, and county health departments that had completed provider agreements in New York State.
  • As more doses and types of vaccine formulations became available, on October 20 DOH began accepting phone orders for vaccines from registered providers.
  • In order to manage the volume of orders placed on any given day, registered providers in each county enter vaccine orders on the particular day of the week assigned to their county.
  • DOH prioritizes the filling of these orders by first filling orders for the largest health care practices serving children and pregnant women. DOH then places orders at the federal level for the shipment of vaccine by the CDC to registered providers.
  • Due to a shortage of vaccine, to date the number of doses requested by registered providers in New York State has far exceeded available vaccine supply.
  • As of November 6, 2009, DOH ordered approximately 1.3 million doses of vaccine – the entire number of doses made available by the CDC – compared with over 7 million doses of vaccine requested by New York State providers.
  • Because orders for vaccine have far exceed available supply, in most cases the shipments of vaccine to providers have been much smaller than the amounts originally requested by providers, and some providers have not yet received any portion of their order.
  • For vaccine orders of lots of 100 doses or more, DOH notifies the CDC of the providers and addresses so that the CDC may directly ship the vaccine to these New York State providers rather than having the vaccine go through DOH for redistribution.
  • The CDC does not allow direct shipment of lots of vaccine containing less than 100 doses. So, for smaller health care practices in New York State ordering less than 100 doses, DOH has the CDC ship larger quantities to DOH, which breaks the order down into smaller lots and ships them to county health departments for distribution to the smaller providers.
  • One of the complicating factors in filling vaccine orders is that there are multiple formulations of vaccine, and these formulations have different restrictions on uses and have been available in varying amounts.
  • The formulations are:
    • Prefilled pediatric syringes for children 6 months to less than three years of age. These vaccines are allocated to health care practices based on the numbers of children in this age group served.
    • Prefilled children/adult syringes, preservative (thimerosal) free. Three preparations: one for ages 3 and up, one for ages 4 and up, and one for ages 18 years and up. These are allocated to obstetrical and family practices based on the numbers of pregnant women served.
    • Nasal spray vaccine approved for ages 2-49 years in people with no underlying health conditions. Some providers prefer not to use nasal spray vaccine, and some have refused to accept it, so this form of the vaccine is only allocated to practices who have ordered it, primarily for children and young adults up to age 24 with no underlying chronic illnesses and for health care workers.
    • Multi-dose vials containing preservative (thimerosal). Three different preparations: one for ages 6 months and up, one for ages 4 years and up, and one for ages 18 years and up.
    • The Department recently waived the preservative-free vaccine requirement for pregnant women and children based on the shortage of this type of vaccine. The CDC considers this vaccine safe for pregnant women and children. The CDC, the Institute of Medicine and all recognized authorities have found no convincing evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site. Thimerosal-free vaccine may be given with the informed consent of the patient or the patient's parent or other person authorized to give consent. For more information, see Commissioner's Letter to Health Care Providers.
  • To date, there have been larger quantities of certain types of vaccine available compared with other types, which affects the amount of vaccine providers receive. For example, if providers order only pre-filled syringes, they may not have received vaccine yet, because to date there has been less of that type of vaccine available. Whenever possible, DOH has been calling providers who ordered pre-filled syringes to see if they would accept another form of the vaccine. Providers who ordered the nasal spray form of the vaccine may have received more vaccine because that vaccine has been in greater supply.
  • The current vaccine shortage is due to unanticipated delays encountered in developing the vaccine at the manufacturing level. For more information on the vaccine delays, a CDC video,"H1N1 Flu Vaccine – Why the Delay?", is available.
  • With larger amounts of vaccine anticipated over the next several weeks, vaccine will become more widely accessible from all providers.
  • The majority of county health departments have indicated they will hold vaccination clinics over the next few weeks. Information about these clinics is available on the county health departments' websites; on the H1N1 page of the DOH website. Click on "Flu Clinics Offered by County Health Departments;" and on the CDC website